{ "hospital_name": "Hollywood Presbyterian Medical Center", "last_updated_on": "2026-03-12", "version": "3.0.0", "location_name": [ "Hollywood Presbyterian Medical Center" ], "hospital_address": [ "1300 N Vermont Ave, Los Angeles, CA 90027, Los Angeles, CA 90027" ], "license_information": { "state": "CA" }, "type_2_npi": [ "1922033547" ], "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": "First Last" }, "standard_charge_information": [ { "description": "Hhcp-serv of pt,ea 15 min", "code_information": [ { "code": "G0151", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Pharmacy - Erythropoietin (EPO) less than 10,000 units", "code_information": [ { "code": "0634", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Radiology - Therapeutic and/or Chemotherapy Administration - General Classification", "code_information": [ { "code": "0330", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1557, "methodology": "case rate", "median_amount": 1557, "10th_percentile": 1557, "90th_percentile": 1557, "count": "1 through 10" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1140, "methodology": "case rate", "median_amount": 1140, "10th_percentile": 1140, "90th_percentile": 1140, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1140, "methodology": "case rate", "median_amount": 1140, "10th_percentile": 1140, "90th_percentile": 1140, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1140, "methodology": "case rate", "median_amount": 1140, "10th_percentile": 1140, "90th_percentile": 1140, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1140, "methodology": "case rate", "median_amount": 1140, "10th_percentile": 1140, "90th_percentile": 1140, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1140, "methodology": "case rate", "median_amount": 1140, "10th_percentile": 1140, "90th_percentile": 1140, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1140, "maximum": 4668 } ] }, { "description": "Skilled Nursing - General Classification", "code_information": [ { "code": "0550", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1401, "maximum": 1401 } ] }, { "description": "Subacute Care - General Classification", "code_information": [ { "code": "0190", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 689, "methodology": "per diem", "median_amount": 689, "10th_percentile": 689, "90th_percentile": 689, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_dollar": 900, "methodology": "per diem", "median_amount": 900, "10th_percentile": 900, "90th_percentile": 900, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_dollar": 1271, "methodology": "per diem", "median_amount": 1271, "10th_percentile": 1271, "90th_percentile": 1271, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_dollar": 583, "methodology": "per diem", "median_amount": 583, "10th_percentile": 583, "90th_percentile": 583, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_dollar": 675, "methodology": "per diem", "median_amount": 675, "10th_percentile": 675, "90th_percentile": 675, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_dollar": 960, "methodology": "per diem", "median_amount": 960, "10th_percentile": 960, "90th_percentile": 960, "count": "1 through 10" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 862.1, "methodology": "per diem", "median_amount": 862.1, "10th_percentile": 862.1, "90th_percentile": 862.1, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1059.73, "methodology": "per diem", "median_amount": 1059.73, "10th_percentile": 1059.73, "90th_percentile": 1059.73, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "per diem", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 583, "maximum": 1401 } ] }, { "description": "Subacute Care - Level I", "code_information": [ { "code": "0191", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 689, "methodology": "per diem", "median_amount": 689, "10th_percentile": 689, "90th_percentile": 689, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 250, "methodology": "per diem", "median_amount": 250, "10th_percentile": 250, "90th_percentile": 250, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_dollar": 900, "methodology": "per diem", "median_amount": 900, "10th_percentile": 900, "90th_percentile": 900, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_dollar": 543, "methodology": "per diem", "median_amount": 543, "10th_percentile": 543, "90th_percentile": 543, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_dollar": 583, "methodology": "per diem", "median_amount": 583, "10th_percentile": 583, "90th_percentile": 583, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225, "methodology": "per diem", "median_amount": 225, "10th_percentile": 225, "90th_percentile": 225, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 862.1, "methodology": "per diem", "median_amount": 862.1, "10th_percentile": 862.1, "90th_percentile": 862.1, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1059.73, "methodology": "per diem", "median_amount": 1059.73, "10th_percentile": 1059.73, "90th_percentile": 1059.73, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "per diem", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 225, "maximum": 1401 } ] }, { "description": "Hhcp-serv of ot,ea 15 min", "code_information": [ { "code": "G0152", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Subacute Care - Level II", "code_information": [ { "code": "0192", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 689, "methodology": "per diem", "median_amount": 689, "10th_percentile": 689, "90th_percentile": 689, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_dollar": 664, "methodology": "per diem", "median_amount": 664, "10th_percentile": 664, "90th_percentile": 664, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_dollar": 765, "methodology": "per diem", "median_amount": 765, "10th_percentile": 765, "90th_percentile": 765, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_dollar": 315, "methodology": "per diem", "median_amount": 315, "10th_percentile": 315, "90th_percentile": 315, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 862.1, "methodology": "per diem", "median_amount": 862.1, "10th_percentile": 862.1, "90th_percentile": 862.1, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1059.73, "methodology": "per diem", "median_amount": 1059.73, "10th_percentile": 1059.73, "90th_percentile": 1059.73, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "per diem", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 315, "maximum": 1401 } ] }, { "description": "Subacute Care - Level III", "code_information": [ { "code": "0193", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 689, "methodology": "per diem", "median_amount": 689, "10th_percentile": 689, "90th_percentile": 689, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1603.35, "methodology": "per diem", "median_amount": 1603.35, "10th_percentile": 1603.35, "90th_percentile": 1603.35, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1603.35, "methodology": "per diem", "median_amount": 1603.35, "10th_percentile": 1603.35, "90th_percentile": 1603.35, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1603.35, "methodology": "per diem", "median_amount": 1603.35, "10th_percentile": 1603.35, "90th_percentile": 1603.35, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 1603.35, "methodology": "per diem", "median_amount": 1603.35, "10th_percentile": 1603.35, "90th_percentile": 1603.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_dollar": 935, "methodology": "per diem", "median_amount": 935, "10th_percentile": 935, "90th_percentile": 935, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_dollar": 875, "methodology": "per diem", "median_amount": 875, "10th_percentile": 875, "90th_percentile": 875, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_dollar": 425, "methodology": "per diem", "median_amount": 425, "10th_percentile": 425, "90th_percentile": 425, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 862.1, "methodology": "per diem", "median_amount": 862.1, "10th_percentile": 862.1, "90th_percentile": 862.1, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1059.73, "methodology": "per diem", "median_amount": 1059.73, "10th_percentile": 1059.73, "90th_percentile": 1059.73, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "per diem", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 425, "maximum": 1603.35 } ] }, { "description": "Subacute Care - Level IV", "code_information": [ { "code": "0194", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 689, "methodology": "per diem", "median_amount": 689, "10th_percentile": 689, "90th_percentile": 689, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1379, "methodology": "per diem", "median_amount": 1379, "10th_percentile": 1379, "90th_percentile": 1379, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1680, "methodology": "per diem", "median_amount": 1680, "10th_percentile": 1680, "90th_percentile": 1680, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1680, "methodology": "per diem", "median_amount": 1680, "10th_percentile": 1680, "90th_percentile": 1680, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1680, "methodology": "per diem", "median_amount": 1680, "10th_percentile": 1680, "90th_percentile": 1680, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 1680, "methodology": "per diem", "median_amount": 1680, "10th_percentile": 1680, "90th_percentile": 1680, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_dollar": 935, "methodology": "per diem", "median_amount": 935, "10th_percentile": 935, "90th_percentile": 935, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_dollar": 875, "methodology": "per diem", "median_amount": 875, "10th_percentile": 875, "90th_percentile": 875, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_dollar": 500, "methodology": "per diem", "median_amount": 500, "10th_percentile": 500, "90th_percentile": 500, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 981, "methodology": "per diem", "median_amount": 981, "10th_percentile": 981, "90th_percentile": 981, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 862.1, "methodology": "per diem", "median_amount": 862.1, "10th_percentile": 862.1, "90th_percentile": 862.1, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1059.73, "methodology": "per diem", "median_amount": 1059.73, "10th_percentile": 1059.73, "90th_percentile": 1059.73, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "per diem", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 500, "maximum": 1680 } ] }, { "description": "Pharmacy - Erythropoietin (EPO) 10,000 or more units", "code_information": [ { "code": "0635", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Pharmacy - Drugs Requiring Detailed Coding", "code_information": [ { "code": "0636", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 22.1, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 22.1, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 22.1, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 22.1, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 35.4, "methodology": "percent of total billed charges", "median_amount": 40.71, "10th_percentile": 20.89, "90th_percentile": 522.57, "count": "673" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 35.4, "methodology": "percent of total billed charges", "median_amount": 40.71, "10th_percentile": 20.89, "90th_percentile": 522.57, "count": "673" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 35.4, "methodology": "percent of total billed charges", "median_amount": 40.71, "10th_percentile": 20.89, "90th_percentile": 522.57, "count": "673" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 35.4, "methodology": "percent of total billed charges", "median_amount": 40.71, "10th_percentile": 20.89, "90th_percentile": 522.57, "count": "673" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 84, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 99.36, "10th_percentile": 22.96, "90th_percentile": 574.54, "count": "193" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 99.36, "10th_percentile": 22.96, "90th_percentile": 574.54, "count": "193" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 99.36, "10th_percentile": 22.96, "90th_percentile": 574.54, "count": "193" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 99.36, "10th_percentile": 22.96, "90th_percentile": 574.54, "count": "193" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 99.36, "10th_percentile": 22.96, "90th_percentile": 574.54, "count": "193" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "median_amount": 23.1, "10th_percentile": 19.91, "90th_percentile": 516.67, "count": "31" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 159.86, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 159.86, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 159.86, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 159.86, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "median_amount": 12.23, "10th_percentile": 10.62, "90th_percentile": 265.72, "count": "556" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 44.76, "10th_percentile": 23.54, "90th_percentile": 574.54, "count": "234" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 12.23, "maximum": 99.36 } ] }, { "description": "Radiology - Therapeutic - Chemotherapy Administration - Injected", "code_information": [ { "code": "0331", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1947, "methodology": "case rate", "median_amount": 1947, "10th_percentile": 1947, "90th_percentile": 1947, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1519, "maximum": 4668 } ] }, { "description": "Hhcp-svs of s/l path,ea 15mn", "code_information": [ { "code": "G0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Subacute Care - Other", "code_information": [ { "code": "0199", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 689, "methodology": "per diem", "median_amount": 689, "10th_percentile": 689, "90th_percentile": 689, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1242, "methodology": "per diem", "median_amount": 1242, "10th_percentile": 1242, "90th_percentile": 1242, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_dollar": 900, "methodology": "per diem", "median_amount": 900, "10th_percentile": 900, "90th_percentile": 900, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_dollar": 1271, "methodology": "per diem", "median_amount": 1271, "10th_percentile": 1271, "90th_percentile": 1271, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_dollar": 583, "methodology": "per diem", "median_amount": 583, "10th_percentile": 583, "90th_percentile": 583, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_dollar": 675, "methodology": "per diem", "median_amount": 675, "10th_percentile": 675, "90th_percentile": 675, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1401, "methodology": "per diem", "median_amount": 1401, "10th_percentile": 1401, "90th_percentile": 1401, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_dollar": 960, "methodology": "per diem", "median_amount": 960, "10th_percentile": 960, "90th_percentile": 960, "count": "1 through 10" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1038, "methodology": "per diem", "median_amount": 1038, "10th_percentile": 1038, "90th_percentile": 1038, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 862.1, "methodology": "per diem", "median_amount": 862.1, "10th_percentile": 862.1, "90th_percentile": 862.1, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1059.73, "methodology": "per diem", "median_amount": 1059.73, "10th_percentile": 1059.73, "90th_percentile": 1059.73, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1300, "methodology": "per diem", "median_amount": 1300, "10th_percentile": 1300, "90th_percentile": 1300, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 583, "maximum": 1401 } ] }, { "description": "Operating Room Services - General Classification", "code_information": [ { "code": "0360", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Bella Vista IPA", "plan_name": "Medicare - HMO Risk", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 19, "methodology": "percent of total billed charges", "median_amount": 1384.21, "10th_percentile": 47.5, "90th_percentile": 1900, "count": "83" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_percentage": 170.6, "methodology": "fee schedule", "median_amount": 1538, "10th_percentile": 427.93, "90th_percentile": 1538, "count": "13" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "median_amount": 1500, "10th_percentile": 1500, "90th_percentile": 1500, "count": "1 through 10" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 3925, "methodology": "fee schedule", "median_amount": 3925, "10th_percentile": 3925, "90th_percentile": 3925, "count": "1 through 10" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "median_amount": 1697.5, "10th_percentile": 1697.5, "90th_percentile": 4729.72, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 6194, "methodology": "case rate", "median_amount": 6194, "10th_percentile": 6194, "90th_percentile": 6194, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 113.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 150, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1384.21, "maximum": 6194 } ] }, { "description": "Operating Room Services - Minor Surgery", "code_information": [ { "code": "0361", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Bella Vista IPA", "plan_name": "Medicare - HMO Risk", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1834, "methodology": "case rate", "median_amount": 1834, "10th_percentile": 1834, "90th_percentile": 1834, "count": "1 through 10" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 19, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 113.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 150, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1834, "maximum": 4399.5 } ] }, { "description": "Operating Room Services - Organ transplant - Other Than Kidney", "code_information": [ { "code": "0362", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Bella Vista IPA", "plan_name": "Medicare - HMO Risk", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 150, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 111.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 4399.5, "methodology": "case rate", "median_amount": 4399.5, "10th_percentile": 4399.5, "90th_percentile": 4399.5, "count": "1 through 10" } ], "minimum": 4399.5, "maximum": 4399.5 } ] }, { "description": "Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices", "code_information": [ { "code": "0274", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 14.81, "10th_percentile": 14.81, "90th_percentile": 14.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 14.81, "10th_percentile": 14.81, "90th_percentile": 14.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 14.81, "10th_percentile": 14.81, "90th_percentile": 14.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 14.81, "10th_percentile": 14.81, "90th_percentile": 14.81, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 7525, "methodology": "case rate", "median_amount": 7525, "10th_percentile": 7525, "90th_percentile": 7525, "count": "1 through 10" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 14.81, "maximum": 7525 } ] }, { "description": "Medical/Surgical Supplies and Devices - Pacemaker", "code_information": [ { "code": "0275", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_percentage": 33, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Medical/Surgical Supplies and Devices - Intraocular Lens", "code_information": [ { "code": "0276", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 233.52, "10th_percentile": 233.52, "90th_percentile": 233.52, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 233.52, "10th_percentile": 233.52, "90th_percentile": 233.52, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 233.52, "10th_percentile": 233.52, "90th_percentile": 233.52, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 233.52, "10th_percentile": 233.52, "90th_percentile": 233.52, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 233.52, "10th_percentile": 233.52, "90th_percentile": 233.52, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 233.52, "10th_percentile": 233.52, "90th_percentile": 233.52, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "median_amount": 108, "10th_percentile": 108, "90th_percentile": 108, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 108, "maximum": 233.52 } ] }, { "description": "Medical/Surgical Supplies and Devices - Other Implants", "code_information": [ { "code": "0278", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 90.9, "90th_percentile": 4545, "count": "17" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 90.9, "90th_percentile": 4545, "count": "17" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 90.9, "90th_percentile": 4545, "count": "17" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 90.9, "90th_percentile": 4545, "count": "17" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 1212, "10th_percentile": 242.4, "90th_percentile": 6060, "count": "50" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 1212, "10th_percentile": 242.4, "90th_percentile": 6060, "count": "50" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 1212, "10th_percentile": 242.4, "90th_percentile": 6060, "count": "50" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 40.400000000000006, "methodology": "percent of total billed charges", "median_amount": 1212, "10th_percentile": 242.4, "90th_percentile": 6060, "count": "50" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_percentage": 33, "methodology": "percent of total billed charges", "median_amount": 2475, "10th_percentile": 2475, "90th_percentile": 2475, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 583.8, "10th_percentile": 583.8, "90th_percentile": 3840.24, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 1167.6, "10th_percentile": 350.28, "90th_percentile": 7911.66, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 1167.6, "10th_percentile": 350.28, "90th_percentile": 7911.66, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 1167.6, "10th_percentile": 350.28, "90th_percentile": 7911.66, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 1167.6, "10th_percentile": 350.28, "90th_percentile": 7911.66, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 1167.6, "10th_percentile": 350.28, "90th_percentile": 7911.66, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 3925, "methodology": "fee schedule", "median_amount": 3925, "10th_percentile": 3925, "90th_percentile": 3925, "count": "1 through 10" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "median_amount": 315, "10th_percentile": 315, "90th_percentile": 315, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "median_amount": 432, "10th_percentile": 54, "90th_percentile": 1350, "count": "60" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 315, "maximum": 3925 } ] }, { "description": "Medical/Surgical Supplies and Devices - Other", "code_information": [ { "code": "0279", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Solid skin barrier", "code_information": [ { "code": "A4362", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Hospital observation per hr", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_dollar": 30, "methodology": "fee schedule", "median_amount": 30, "10th_percentile": 30, "90th_percentile": 30, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_dollar": 1125, "methodology": "case rate", "median_amount": 1125, "10th_percentile": 1125, "90th_percentile": 1125, "count": "1 through 10" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "median_amount": 4547.03, "10th_percentile": 1326.22, "90th_percentile": 9851.9, "count": "1 through 10" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_dollar": 362, "methodology": "per diem", "median_amount": 362, "10th_percentile": 362, "90th_percentile": 362, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2578.67, "methodology": "case rate", "median_amount": 2578.67, "10th_percentile": 2578.67, "90th_percentile": 2578.67, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2097.78, "methodology": "case rate", "median_amount": 2097.78, "10th_percentile": 2097.78, "90th_percentile": 2097.78, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1825, "methodology": "case rate", "median_amount": 1825, "10th_percentile": 1825, "90th_percentile": 1825, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2871.75, "methodology": "case rate", "median_amount": 2871.75, "10th_percentile": 2871.75, "90th_percentile": 2871.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2871.75, "methodology": "case rate", "median_amount": 2871.75, "10th_percentile": 2871.75, "90th_percentile": 2871.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2871.75, "methodology": "case rate", "median_amount": 2871.75, "10th_percentile": 2871.75, "90th_percentile": 2871.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2871.75, "methodology": "case rate", "median_amount": 2871.75, "10th_percentile": 2871.75, "90th_percentile": 2871.75, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 30, "maximum": 4547.03 } ] }, { "description": "Medical/Surgical Supplies and Devices - Oxygen - Take Home", "code_information": [ { "code": "0277", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Room & Board - Private (One Bed) - Rehabilitation", "code_information": [ { "code": "0118", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1771, "methodology": "per diem", "median_amount": 1771, "10th_percentile": 1771, "90th_percentile": 1771, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2120, "methodology": "per diem", "median_amount": 2120, "10th_percentile": 2120, "90th_percentile": 2120, "count": "1 through 10" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1185, "methodology": "per diem", "median_amount": 1185, "10th_percentile": 1185, "90th_percentile": 1185, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 1480.52, "methodology": "per diem", "median_amount": 1480.52, "10th_percentile": 1480.52, "90th_percentile": 1480.52, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1819.91, "methodology": "per diem", "median_amount": 1819.91, "10th_percentile": 1819.91, "90th_percentile": 1819.91, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1450, "methodology": "per diem", "median_amount": 1450, "10th_percentile": 1450, "90th_percentile": 1450, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 155, "methodology": "fee schedule", "median_amount": 1911.15, "10th_percentile": 1911.15, "90th_percentile": 1911.15, "count": "43" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_dollar": 1880, "methodology": "per diem", "median_amount": 1880, "10th_percentile": 1880, "90th_percentile": 1880, "count": "1 through 10" } ], "minimum": 1185, "maximum": 16000 } ] }, { "description": "Room & Board - Semi-private (Two Beds) - General Classification", "code_information": [ { "code": "0120", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 850, "methodology": "per diem", "median_amount": 850, "10th_percentile": 850, "90th_percentile": 850, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1839, "methodology": "per diem", "median_amount": 1839, "10th_percentile": 1839, "90th_percentile": 1839, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "median_amount": 2225.77, "10th_percentile": 2225.77, "90th_percentile": 2225.77, "count": "1 through 10" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "median_amount": 2225.77, "10th_percentile": 2225.77, "90th_percentile": 2225.77, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2825.95, "methodology": "per diem", "median_amount": 2825.95, "10th_percentile": 2825.95, "90th_percentile": 2825.95, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2298.94, "methodology": "per diem", "median_amount": 2298.94, "10th_percentile": 2298.94, "90th_percentile": 2298.94, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 850, "maximum": 16000 } ] }, { "description": "Adhesive, liquid or equal", "code_information": [ { "code": "A4364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Ostomy belt", "code_information": [ { "code": "A4367", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Skin barrier powder per oz", "code_information": [ { "code": "A4371", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Ostomy irrigation bag", "code_information": [ { "code": "A4398", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Ostomy irrigation set", "code_information": [ { "code": "A4400", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Ost pch drain 2 piece system", "code_information": [ { "code": "A4426", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Pouch clsd w barr attached", "code_information": [ { "code": "A5051", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Clsd ostomy pouch w/flange", "code_information": [ { "code": "A5054", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Cervical orthosis (collar) preformed, foam, prefabricated, off-the-shelf.", "code_information": [ { "code": "L0140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Cervical orthosis (e.g., Philadelphia-type) two-piece, prefabricated, off-the-shelf.", "code_information": [ { "code": "L0172", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Thoracic-lumbar-sacral orthosis rigid, two-piece with posterior panel, prefabricated.", "code_information": [ { "code": "L0472", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Lumbar-sacral orthosis flexible, anterior-posterior lateral-control, prefabricated.", "code_information": [ { "code": "L0627", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Lumbar-sacral orthosis rigid, anterior-posterior lateral-control, prefabricated.", "code_information": [ { "code": "L0631", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Lumbar-sacral orthosis rigid, with lateral-control, prefabricated, off-the-shelf.", "code_information": [ { "code": "L0635", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Lumbar-sacral orthosis rigid, with posterior-panel, prefabricated, off-the-shelf.", "code_information": [ { "code": "L0637", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Addition to lower-extremity orthosis, pelvic control belt/strap, each.", "code_information": [ { "code": "L0976", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Addition to upper-extremity orthosis, forearm pronation/supination control.", "code_information": [ { "code": "L1090", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Addition to lower-extremity orthosis, hip-joint, abduction control, any type.", "code_information": [ { "code": "L1686", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Room & Board - Semi-private (Two Beds) - Rehabilitation", "code_information": [ { "code": "0128", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1771, "methodology": "per diem", "median_amount": 1771, "10th_percentile": 1771, "90th_percentile": 1771, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2120, "methodology": "per diem", "median_amount": 2120, "10th_percentile": 2120, "90th_percentile": 2120, "count": "1 through 10" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1185, "methodology": "per diem", "median_amount": 1185, "10th_percentile": 1185, "90th_percentile": 1185, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "median_amount": 2090, "10th_percentile": 2090, "90th_percentile": 2090, "count": "36" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "median_amount": 2090, "10th_percentile": 2090, "90th_percentile": 2090, "count": "36" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 1480.52, "methodology": "per diem", "median_amount": 1480.52, "10th_percentile": 1480.52, "90th_percentile": 1480.52, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1819.91, "methodology": "per diem", "median_amount": 1819.91, "10th_percentile": 1819.91, "90th_percentile": 1819.91, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1450, "methodology": "per diem", "median_amount": 1450, "10th_percentile": 1450, "90th_percentile": 1450, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 155, "methodology": "fee schedule", "median_amount": 1911.15, "10th_percentile": 1911.15, "90th_percentile": 1911.15, "count": "300" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_dollar": 1880, "methodology": "per diem", "median_amount": 1880, "10th_percentile": 1880, "90th_percentile": 1880, "count": "1 through 10" } ], "minimum": 1185, "maximum": 16000 } ] }, { "description": "Room & Board - Semi-private (Two Beds) - Other", "code_information": [ { "code": "0129", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 850, "methodology": "per diem", "median_amount": 850, "10th_percentile": 850, "90th_percentile": 850, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1839, "methodology": "per diem", "median_amount": 1839, "10th_percentile": 1839, "90th_percentile": 1839, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2825.95, "methodology": "per diem", "median_amount": 2825.95, "10th_percentile": 2825.95, "90th_percentile": 2825.95, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2298.94, "methodology": "per diem", "median_amount": 2298.94, "10th_percentile": 2298.94, "90th_percentile": 2298.94, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 850, "maximum": 16000 } ] }, { "description": "Room & Board - Three and Four Beds - Rehabilitation", "code_information": [ { "code": "0138", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1771, "methodology": "per diem", "median_amount": 1771, "10th_percentile": 1771, "90th_percentile": 1771, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2120, "methodology": "per diem", "median_amount": 2120, "10th_percentile": 2120, "90th_percentile": 2120, "count": "1 through 10" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1185, "methodology": "per diem", "median_amount": 1185, "10th_percentile": 1185, "90th_percentile": 1185, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 1480.52, "methodology": "per diem", "median_amount": 1480.52, "10th_percentile": 1480.52, "90th_percentile": 1480.52, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1819.91, "methodology": "per diem", "median_amount": 1819.91, "10th_percentile": 1819.91, "90th_percentile": 1819.91, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1450, "methodology": "per diem", "median_amount": 1450, "10th_percentile": 1450, "90th_percentile": 1450, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_dollar": 1880, "methodology": "per diem", "median_amount": 1880, "10th_percentile": 1880, "90th_percentile": 1880, "count": "1 through 10" } ], "minimum": 1185, "maximum": 16000 } ] }, { "description": "Room & Board - Three and Four Beds - Other", "code_information": [ { "code": "0139", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 850, "methodology": "per diem", "median_amount": 850, "10th_percentile": 850, "90th_percentile": 850, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1839, "methodology": "per diem", "median_amount": 1839, "10th_percentile": 1839, "90th_percentile": 1839, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2825.95, "methodology": "per diem", "median_amount": 2825.95, "10th_percentile": 2825.95, "90th_percentile": 2825.95, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2298.94, "methodology": "per diem", "median_amount": 2298.94, "10th_percentile": 2298.94, "90th_percentile": 2298.94, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 850, "maximum": 16000 } ] }, { "description": "Room & Board - Deluxe Private - Rehabilitation", "code_information": [ { "code": "0148", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1771, "methodology": "per diem", "median_amount": 1771, "10th_percentile": 1771, "90th_percentile": 1771, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2120, "methodology": "per diem", "median_amount": 2120, "10th_percentile": 2120, "90th_percentile": 2120, "count": "1 through 10" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1185, "methodology": "per diem", "median_amount": 1185, "10th_percentile": 1185, "90th_percentile": 1185, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 1480.52, "methodology": "per diem", "median_amount": 1480.52, "10th_percentile": 1480.52, "90th_percentile": 1480.52, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1819.91, "methodology": "per diem", "median_amount": 1819.91, "10th_percentile": 1819.91, "90th_percentile": 1819.91, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1450, "methodology": "per diem", "median_amount": 1450, "10th_percentile": 1450, "90th_percentile": 1450, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_dollar": 1880, "methodology": "per diem", "median_amount": 1880, "10th_percentile": 1880, "90th_percentile": 1880, "count": "1 through 10" } ], "minimum": 1185, "maximum": 16000 } ] }, { "description": "Room & Board - Ward - Rehabilitation", "code_information": [ { "code": "0158", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 1594, "methodology": "per diem", "median_amount": 1594, "10th_percentile": 1594, "90th_percentile": 1594, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1771, "methodology": "per diem", "median_amount": 1771, "10th_percentile": 1771, "90th_percentile": 1771, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2120, "methodology": "per diem", "median_amount": 2120, "10th_percentile": 2120, "90th_percentile": 2120, "count": "1 through 10" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1930, "methodology": "per diem", "median_amount": 1930, "10th_percentile": 1930, "90th_percentile": 1930, "count": "1 through 10" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1185, "methodology": "per diem", "median_amount": 1185, "10th_percentile": 1185, "90th_percentile": 1185, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 1480.52, "methodology": "per diem", "median_amount": 1480.52, "10th_percentile": 1480.52, "90th_percentile": 1480.52, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 1819.91, "methodology": "per diem", "median_amount": 1819.91, "10th_percentile": 1819.91, "90th_percentile": 1819.91, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1651, "methodology": "per diem", "median_amount": 1651, "10th_percentile": 1651, "90th_percentile": 1651, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 1450, "methodology": "per diem", "median_amount": 1450, "10th_percentile": 1450, "90th_percentile": 1450, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 155, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_dollar": 2112, "methodology": "per diem", "median_amount": 2112, "10th_percentile": 2112, "90th_percentile": 2112, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_dollar": 1880, "methodology": "per diem", "median_amount": 1880, "10th_percentile": 1880, "90th_percentile": 1880, "count": "1 through 10" } ], "minimum": 1185, "maximum": 16000 } ] }, { "description": "SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT", "code_information": [ { "code": "315", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT", "code_information": [ { "code": "315", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "HAND AND WRIST PROCEDURES", "code_information": [ { "code": "316", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "HAND AND WRIST PROCEDURES", "code_information": [ { "code": "316", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "HAND AND WRIST PROCEDURES", "code_information": [ { "code": "316", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "HAND AND WRIST PROCEDURES", "code_information": [ { "code": "316", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES", "code_information": [ { "code": "317", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES", "code_information": [ { "code": "317", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES", "code_information": [ { "code": "317", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 18797.55, "10th_percentile": 18797.55, "90th_percentile": 18797.55, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 18797.55, "maximum": 18797.55 } ] }, { "description": "Knee orthosis, elastic with single upright, medial-lateral support, prefabricated.", "code_information": [ { "code": "L1820", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Knee orthosis, adjustable knee joint with rigid support, prefabricated.", "code_information": [ { "code": "L1832", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "KAFO – knee-ankle-foot orthosis, single upright, free knee, solid ankle, prefabricated.", "code_information": [ { "code": "L2036", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Pacemaker, dual chamber, rate-responsive (implantable)", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 5182.5, "10th_percentile": 5182.5, "90th_percentile": 5182.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 5182.5, "10th_percentile": 5182.5, "90th_percentile": 5182.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 5182.5, "10th_percentile": 5182.5, "90th_percentile": 5182.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 5182.5, "10th_percentile": 5182.5, "90th_percentile": 5182.5, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 5182.5 } ] }, { "description": "Cardioverter-defibrillator, other than single or dual chamber (implantable)", "code_information": [ { "code": "C1882", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Lead, pacemaker, other than transvenous vdd single pass", "code_information": [ { "code": "C1898", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 829.2, "10th_percentile": 829.2, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 829.2, "10th_percentile": 829.2, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 829.2, "10th_percentile": 829.2, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 829.2, "10th_percentile": 829.2, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 8322.16, "10th_percentile": 8322.16, "90th_percentile": 8322.16, "count": "1 through 10" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 829.2, "maximum": 8322.16 } ] }, { "description": "Lens, intraocular (new technology)", "code_information": [ { "code": "C1780", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Anter chamber intraocul lens", "code_information": [ { "code": "V2630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Post chmbr intraocular lens", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "median_amount": 150, "10th_percentile": 150, "90th_percentile": 150, "count": "1 through 10" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 142.87, "10th_percentile": 142.87, "90th_percentile": 142.87, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 180, "10th_percentile": 180, "90th_percentile": 180, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 142.87, "maximum": 2543.35 } ] }, { "description": "Intratubal occlusion device", "code_information": [ { "code": "A4264", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Implantable access syst perc", "code_information": [ { "code": "A4301", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Urinary cath anchor device", "code_information": [ { "code": "A4333", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_percentage": 103, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Slings", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 107, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Implantable tissue marker", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 504, "10th_percentile": 420, "90th_percentile": 504, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 540, "10th_percentile": 180, "90th_percentile": 1800, "count": "12" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1451.1, "10th_percentile": 310.95, "90th_percentile": 3109.5, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1451.1, "10th_percentile": 310.95, "90th_percentile": 3109.5, "count": "25" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1451.1, "10th_percentile": 310.95, "90th_percentile": 3109.5, "count": "25" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1451.1, "10th_percentile": 310.95, "90th_percentile": 3109.5, "count": "25" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 504, "maximum": 2543.35 } ] }, { "description": "Catheter, transluminal atherectomy, directional", "code_information": [ { "code": "C1714", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 336, "10th_percentile": 252, "90th_percentile": 336, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 621.9, "10th_percentile": 621.9, "90th_percentile": 621.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 621.9, "10th_percentile": 621.9, "90th_percentile": 621.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 621.9, "10th_percentile": 621.9, "90th_percentile": 621.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 621.9, "10th_percentile": 621.9, "90th_percentile": 621.9, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 363.6, "90th_percentile": 363.6, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 363.6, "90th_percentile": 363.6, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 363.6, "90th_percentile": 363.6, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 363.6, "10th_percentile": 363.6, "90th_percentile": 363.6, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 336, "maximum": 2543.35 } ] }, { "description": "Catheter, balloon dilatation, non-vascular", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 252, "10th_percentile": 252, "90th_percentile": 252, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 252, "maximum": 2543.35 } ] }, { "description": "Catheter, drainage", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 168, "10th_percentile": 168, "90th_percentile": 168, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 180, "10th_percentile": 180, "90th_percentile": 180, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 168, "maximum": 2543.35 } ] }, { "description": "Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)", "code_information": [ { "code": "C1730", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Catheter, hemodialysis/peritoneal, long-term", "code_information": [ { "code": "C1750", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 310.95, "10th_percentile": 310.95, "90th_percentile": 310.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 310.95, "10th_percentile": 310.95, "90th_percentile": 310.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 310.95, "10th_percentile": 310.95, "90th_percentile": 310.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 310.95, "10th_percentile": 310.95, "90th_percentile": 310.95, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 310.95, "maximum": 2543.35 } ] }, { "description": "Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 90, "10th_percentile": 90, "90th_percentile": 90, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 103.65, "10th_percentile": 103.65, "90th_percentile": 103.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 103.65, "10th_percentile": 103.65, "90th_percentile": 103.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 103.65, "10th_percentile": 103.65, "90th_percentile": 103.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 103.65, "10th_percentile": 103.65, "90th_percentile": 103.65, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 90, "maximum": 2543.35 } ] }, { "description": "Catheter, intravascular ultrasound", "code_information": [ { "code": "C1753", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Catheter, thrombectomy/embolectomy", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 9999, "10th_percentile": 9999, "90th_percentile": 9999, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 9999, "10th_percentile": 9999, "90th_percentile": 9999, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 9999, "10th_percentile": 9999, "90th_percentile": 9999, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 9999, "10th_percentile": 9999, "90th_percentile": 9999, "count": "1 through 10" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 9999 } ] }, { "description": "Catheter, ureteral", "code_information": [ { "code": "C1758", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 42, "10th_percentile": 42, "90th_percentile": 42, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "median_amount": 54, "10th_percentile": 27, "90th_percentile": 54, "count": "1 through 10" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 45, "10th_percentile": 45, "90th_percentile": 180, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 42, "maximum": 2543.35 } ] }, { "description": "Closure device, vascular (implantable/insertable)", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 450, "10th_percentile": 450, "90th_percentile": 450, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 450, "maximum": 2543.35 } ] }, { "description": "Connective tissue, human (includes fascia lata)", "code_information": [ { "code": "C1762", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Connective tissue, non-human (includes synthetic)", "code_information": [ { "code": "C1763", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 2700, "10th_percentile": 2700, "90th_percentile": 3600, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2700 } ] }, { "description": "Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away", "code_information": [ { "code": "C1766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Graft, vascular", "code_information": [ { "code": "C1768", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 2700, "10th_percentile": 2700, "90th_percentile": 2700, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2700 } ] }, { "description": "Guide wire", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 84, "10th_percentile": 42, "90th_percentile": 104.5, "count": "11" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "median_amount": 54, "10th_percentile": 27, "90th_percentile": 486, "count": "1 through 10" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 135, "10th_percentile": 45, "90th_percentile": 360, "count": "13" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 207.3, "10th_percentile": 51.83, "90th_percentile": 932.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 207.3, "10th_percentile": 51.83, "90th_percentile": 932.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 207.3, "10th_percentile": 51.83, "90th_percentile": 932.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 207.3, "10th_percentile": 51.83, "90th_percentile": 932.85, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 45.45, "90th_percentile": 272.7, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 45.45, "90th_percentile": 272.7, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 45.45, "90th_percentile": 272.7, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 45.45, "90th_percentile": 272.7, "count": "1 through 10" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 54, "maximum": 2543.35 } ] }, { "description": "Repair device, urinary, incontinence, with sling graft", "code_information": [ { "code": "C1771", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Joint device (implantable)", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 5040, "10th_percentile": 5040, "90th_percentile": 5040, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 1800, "10th_percentile": 810, "90th_percentile": 7200, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 8292, "10th_percentile": 8292, "90th_percentile": 8292, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 8292, "10th_percentile": 8292, "90th_percentile": 8292, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 8292, "10th_percentile": 8292, "90th_percentile": 8292, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 8292, "10th_percentile": 8292, "90th_percentile": 8292, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1800, "maximum": 8292 } ] }, { "description": "Mesh (implantable)", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 630, "10th_percentile": 630, "90th_percentile": 1260, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "median_amount": 360, "10th_percentile": 360, "90th_percentile": 360, "count": "1 through 10" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 360, "10th_percentile": 270, "90th_percentile": 1350, "count": "11" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 360, "maximum": 2543.35 } ] }, { "description": "Port, indwelling (implantable)", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 270, "10th_percentile": 270, "90th_percentile": 270, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 270, "maximum": 2543.35 } ] }, { "description": "Prosthesis, urinary sphincter (implantable)", "code_information": [ { "code": "C1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Surgical tissue localization and excision device (implantable)", "code_information": [ { "code": "C1819", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Stent, coated/covered, with delivery system", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 2520, "10th_percentile": 2520, "90th_percentile": 2520, "count": "1 through 10" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 1363.5, "10th_percentile": 1363.5, "90th_percentile": 1363.5, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 1363.5, "10th_percentile": 1363.5, "90th_percentile": 1363.5, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 1363.5, "10th_percentile": 1363.5, "90th_percentile": 1363.5, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 1363.5, "10th_percentile": 1363.5, "90th_percentile": 1363.5, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1363.5, "maximum": 2543.35 } ] }, { "description": "Stent, non-coated/non-covered, with delivery system", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2543.35 } ] }, { "description": "Embolization protective system", "code_information": [ { "code": "C1884", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 2960.1, "10th_percentile": 2960.1, "90th_percentile": 2960.1, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 2543.35, "maximum": 2960.1 } ] }, { "description": "Catheter, guiding (may include infusion/perfusion capability)", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 84, "10th_percentile": 84, "90th_percentile": 2940, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "median_amount": 27, "10th_percentile": 27, "90th_percentile": 27, "count": "1 through 10" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 90, "10th_percentile": 45, "90th_percentile": 360, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 51.83, "10th_percentile": 51.83, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 51.83, "10th_percentile": 51.83, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 51.83, "10th_percentile": 51.83, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 51.83, "10th_percentile": 51.83, "90th_percentile": 829.2, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 90.9, "90th_percentile": 90.9, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 90.9, "90th_percentile": 90.9, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 90.9, "90th_percentile": 90.9, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 90.9, "10th_percentile": 90.9, "90th_percentile": 90.9, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 27, "maximum": 2543.35 } ] }, { "description": "Implantable/insertable device, not otherwise classified", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 2940, "10th_percentile": 2940, "90th_percentile": 2940, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "median_amount": 1125, "10th_percentile": 1125, "90th_percentile": 1125, "count": "1 through 10" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 1350, "10th_percentile": 1350, "90th_percentile": 1350, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 1554.75, "10th_percentile": 1554.75, "90th_percentile": 1554.75, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1125, "maximum": 2940 } ] }, { "description": "Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 840, "10th_percentile": 10.78, "90th_percentile": 2520, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "median_amount": 1080, "10th_percentile": 1080, "90th_percentile": 1080, "count": "1 through 10" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 900, "10th_percentile": 900, "90th_percentile": 900, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 6219, "10th_percentile": 1036.5, "90th_percentile": 9328.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 6219, "10th_percentile": 1036.5, "90th_percentile": 9328.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 6219, "10th_percentile": 1036.5, "90th_percentile": 9328.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "median_amount": 6219, "10th_percentile": 1036.5, "90th_percentile": 9328.5, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 909, "10th_percentile": 909, "90th_percentile": 1818, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 909, "10th_percentile": 909, "90th_percentile": 1818, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 909, "10th_percentile": 909, "90th_percentile": 1818, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "median_amount": 909, "10th_percentile": 909, "90th_percentile": 1818, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 840, "maximum": 6219 } ] }, { "description": "Stent, non-coronary, temporary, without delivery system", "code_information": [ { "code": "C2617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 28.000000000000004, "methodology": "percent of total billed charges", "median_amount": 84, "10th_percentile": 84, "90th_percentile": 84, "count": "1 through 10" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 18, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 30, "methodology": "percent of total billed charges", "median_amount": 90, "10th_percentile": 90, "90th_percentile": 90, "count": "1 through 10" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_percentage": 34.55, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 30.3, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Commercial/POS/Exchange", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Medi-Medi", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Prospect Health Plan", "plan_name": "Dual Eligible Special Needs Plans (D-SNP)", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 84, "maximum": 2543.35 } ] }, { "description": "Pharmacy - General Classification", "code_information": [ { "code": "0250", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "median_amount": 4.95, "10th_percentile": 3.81, "90th_percentile": 246.12, "count": "14" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 7525, "methodology": "case rate", "median_amount": 7525, "10th_percentile": 7525, "90th_percentile": 7525, "count": "1 through 10" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "median_amount": 20.93, "10th_percentile": 20.65, "90th_percentile": 73.5, "count": "122" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "median_amount": 28.92, "10th_percentile": 28.92, "90th_percentile": 28.92, "count": "1 through 10" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 41.87, "10th_percentile": 41.3, "90th_percentile": 147, "count": "613" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 33.45, "10th_percentile": 32.63, "90th_percentile": 118.34, "count": "745" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 33.45, "10th_percentile": 32.63, "90th_percentile": 118.34, "count": "745" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 33.45, "10th_percentile": 32.63, "90th_percentile": 118.34, "count": "745" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 33.45, "10th_percentile": 32.63, "90th_percentile": 118.34, "count": "745" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 4.95, "maximum": 7525 } ] }, { "description": "Pharmacy - Drugs Incident To Other Diagnostic Services", "code_information": [ { "code": "0254", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 2543.35 } ] }, { "description": "Pharmacy - IV Solutions", "code_information": [ { "code": "0258", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "median_amount": 73.5, "10th_percentile": 73.5, "90th_percentile": 73.5, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 107.8, "10th_percentile": 107.8, "90th_percentile": 147, "count": "66" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 85.16, "10th_percentile": 85.16, "90th_percentile": 116.13, "count": "83" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 85.16, "10th_percentile": 85.16, "90th_percentile": 116.13, "count": "83" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 85.16, "10th_percentile": 85.16, "90th_percentile": 116.13, "count": "83" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 85.16, "10th_percentile": 85.16, "90th_percentile": 116.13, "count": "83" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 73.5, "maximum": 2543.35 } ] }, { "description": "Radiology - Therapeutic - Chemotherapy Administration - Oral", "code_information": [ { "code": "0332", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1947, "methodology": "case rate", "median_amount": 1947, "10th_percentile": 1947, "90th_percentile": 1947, "count": "1 through 10" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1519, "maximum": 4668 } ] }, { "description": "TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES", "code_information": [ { "code": "317", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES", "code_information": [ { "code": "320", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "median_amount": 10593.2, "10th_percentile": 10593.2, "90th_percentile": 10593.2, "count": "1 through 10" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "median_amount": 9612, "10th_percentile": 9612, "90th_percentile": 9612, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 10628.66, "10th_percentile": 10485.61, "90th_percentile": 10628.66, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 9612, "maximum": 10628.66 } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES", "code_information": [ { "code": "320", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES", "code_information": [ { "code": "320", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES", "code_information": [ { "code": "320", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES", "code_information": [ { "code": "321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "median_amount": 15816.98, "10th_percentile": 15816.98, "90th_percentile": 15816.98, "count": "1 through 10" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 15442.89, "10th_percentile": 15442.89, "90th_percentile": 15488.86, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 15442.89, "maximum": 15816.98 } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES", "code_information": [ { "code": "321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 21123.6, "10th_percentile": 18368.35, "90th_percentile": 26563.91, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 21123.6, "maximum": 21123.6 } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES", "code_information": [ { "code": "321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 29067.09, "10th_percentile": 29067.09, "90th_percentile": 29067.09, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 29067.09, "maximum": 29067.09 } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES", "code_information": [ { "code": "321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SHOULDER AND ELBOW JOINT REPLACEMENT", "code_information": [ { "code": "322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SHOULDER AND ELBOW JOINT REPLACEMENT", "code_information": [ { "code": "322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SHOULDER AND ELBOW JOINT REPLACEMENT", "code_information": [ { "code": "322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SHOULDER AND ELBOW JOINT REPLACEMENT", "code_information": [ { "code": "322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT", "code_information": [ { "code": "323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT", "code_information": [ { "code": "323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT", "code_information": [ { "code": "323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT", "code_information": [ { "code": "323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "IV Therapy - General Classification", "code_information": [ { "code": "0260", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 928.68, "methodology": "case rate", "median_amount": 928.68, "10th_percentile": 928.68, "90th_percentile": 928.68, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 3925, "methodology": "fee schedule", "median_amount": 3925, "10th_percentile": 3925, "90th_percentile": 3925, "count": "1 through 10" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "median_amount": 170.55, "10th_percentile": 156.21, "90th_percentile": 528.81, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 823, "methodology": "case rate", "median_amount": 823, "10th_percentile": 823, "90th_percentile": 823, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 823, "methodology": "case rate", "median_amount": 823, "10th_percentile": 823, "90th_percentile": 823, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 823, "methodology": "case rate", "median_amount": 823, "10th_percentile": 823, "90th_percentile": 823, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 823, "methodology": "case rate", "median_amount": 823, "10th_percentile": 823, "90th_percentile": 823, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 823, "methodology": "case rate", "median_amount": 823, "10th_percentile": 823, "90th_percentile": 823, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 309.54, "10th_percentile": 281.82, "90th_percentile": 1615, "count": "228" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 251.23, "10th_percentile": 222.64, "90th_percentile": 753.68, "count": "236" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 251.23, "10th_percentile": 222.64, "90th_percentile": 753.68, "count": "236" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 251.23, "10th_percentile": 222.64, "90th_percentile": 753.68, "count": "236" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 251.23, "10th_percentile": 222.64, "90th_percentile": 753.68, "count": "236" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4561, "methodology": "case rate", "median_amount": 4561, "10th_percentile": 4561, "90th_percentile": 4561, "count": "1 through 10" } ], "minimum": 170.55, "maximum": 4561 } ] }, { "description": "Medical/Surgical Supplies and Devices - General Classification", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 25, "methodology": "percent of total billed charges", "median_amount": 56.1, "10th_percentile": 15.13, "90th_percentile": 78.93, "count": "118" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 109.34, "10th_percentile": 27.72, "90th_percentile": 220.99, "count": "104" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 104.02, "10th_percentile": 33.46, "90th_percentile": 260.96, "count": "156" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 104.02, "10th_percentile": 33.46, "90th_percentile": 260.96, "count": "156" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 104.02, "10th_percentile": 33.46, "90th_percentile": 260.96, "count": "156" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 104.02, "10th_percentile": 33.46, "90th_percentile": 260.96, "count": "156" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 56.1, "maximum": 2543.35 } ] }, { "description": "Medical/Surgical Supplies and Devices - Sterile Supply", "code_information": [ { "code": "0272", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 105, "10th_percentile": 56.98, "90th_percentile": 1615, "count": "41" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 96.72, "10th_percentile": 21.9, "90th_percentile": 770.11, "count": "110" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 96.72, "10th_percentile": 21.9, "90th_percentile": 770.11, "count": "110" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 96.72, "10th_percentile": 21.9, "90th_percentile": 770.11, "count": "110" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "median_amount": 96.72, "10th_percentile": 21.9, "90th_percentile": 770.11, "count": "110" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 96.72, "maximum": 2543.35 } ] }, { "description": "Laboratory - General Classification", "code_information": [ { "code": "0300", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 232.91, "count": "751" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 38.8, "maximum": 2543.35 } ] }, { "description": "Laboratory - Chemistry", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 214.83, "10th_percentile": 44.82, "90th_percentile": 254.93, "count": "764" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 214.83, "maximum": 2543.35 } ] }, { "description": "Laboratory - Immunology", "code_information": [ { "code": "0302", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 81.81, "10th_percentile": 81.81, "90th_percentile": 230.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 81.81, "10th_percentile": 81.81, "90th_percentile": 230.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 81.81, "10th_percentile": 81.81, "90th_percentile": 230.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 81.81, "10th_percentile": 81.81, "90th_percentile": 230.95, "count": "1 through 10" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 97.02, "10th_percentile": 8.3, "90th_percentile": 138.6, "count": "24" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 81.81, "maximum": 2543.35 } ] }, { "description": "Laboratory - Hematology", "code_information": [ { "code": "0305", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 166.32, "10th_percentile": 71.61, "90th_percentile": 166.32, "count": "646" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 166.32, "maximum": 2543.35 } ] }, { "description": "Laboratory - Bacteriology & Microbiology", "code_information": [ { "code": "0306", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 85.32, "10th_percentile": 59.49, "90th_percentile": 271.3, "count": "158" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 85.32, "maximum": 2543.35 } ] }, { "description": "Laboratory - Urology", "code_information": [ { "code": "0307", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 145.53, "10th_percentile": 145.53, "90th_percentile": 145.53, "count": "113" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 145.53, "maximum": 2543.35 } ] }, { "description": "Laboratory - Other", "code_information": [ { "code": "0309", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 146.3, "10th_percentile": 146.3, "90th_percentile": 146.3, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 146.3, "maximum": 2543.35 } ] }, { "description": "Laboratory Pathology - General Classification", "code_information": [ { "code": "0310", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 123.68, "10th_percentile": 56.1, "90th_percentile": 499.8, "count": "37" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 123.68, "10th_percentile": 56.1, "90th_percentile": 499.8, "count": "37" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 123.68, "10th_percentile": 56.1, "90th_percentile": 499.8, "count": "37" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 123.68, "10th_percentile": 56.1, "90th_percentile": 499.8, "count": "37" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 264.6, "10th_percentile": 176.4, "90th_percentile": 814.8, "count": "117" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 123.68, "maximum": 2543.35 } ] }, { "description": "Laboratory Pathology - Cytology", "code_information": [ { "code": "0311", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 2543.35 } ] }, { "description": "Laboratory Pathology - Histology", "code_information": [ { "code": "0312", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 2543.35 } ] }, { "description": "Kyleena, 19.5 mg", "code_information": [ { "code": "J7296", "type": "HCPCS" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" } ], "minimum": 1000, "maximum": 1000 } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT", "code_information": [ { "code": "324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 12305.64, "10th_percentile": 12305.64, "90th_percentile": 12305.64, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "median_amount": 12797.87, "10th_percentile": 12797.87, "90th_percentile": 12797.87, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 15051.49, "10th_percentile": 15051.49, "90th_percentile": 15051.49, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 12305.64, "maximum": 15051.49 } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT", "code_information": [ { "code": "324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 15886.28, "10th_percentile": 15886.28, "90th_percentile": 16036.22, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 15886.28, "maximum": 15886.28 } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT", "code_information": [ { "code": "324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT", "code_information": [ { "code": "324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT", "code_information": [ { "code": "325", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT", "code_information": [ { "code": "325", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT", "code_information": [ { "code": "325", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 29817.12, "10th_percentile": 29817.12, "90th_percentile": 29817.12, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 29817.12, "maximum": 29817.12 } ] }, { "description": "NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT", "code_information": [ { "code": "325", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT", "code_information": [ { "code": "326", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 12205.99, "10th_percentile": 12205.99, "90th_percentile": 12205.99, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "median_amount": 21358.05, "10th_percentile": 21358.05, "90th_percentile": 21358.05, "count": "1 through 10" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "median_amount": 13246.95, "10th_percentile": 13246.95, "90th_percentile": 13246.95, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 14648.07, "10th_percentile": 14036.89, "90th_percentile": 14648.07, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 12205.99, "maximum": 21358.05 } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT", "code_information": [ { "code": "326", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 15469.91, "10th_percentile": 15469.91, "90th_percentile": 15469.91, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 15469.91, "maximum": 15469.91 } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT", "code_information": [ { "code": "326", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT", "code_information": [ { "code": "326", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Radiology - Diagnostic - General Classification", "code_information": [ { "code": "0320", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "median_amount": 246.69, "10th_percentile": 246.69, "90th_percentile": 370.46, "count": "22" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 445.06, "10th_percentile": 445.06, "90th_percentile": 579.04, "count": "371" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2579.2, "10th_percentile": 2579.2, "90th_percentile": 2579.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2579.2, "10th_percentile": 2579.2, "90th_percentile": 2579.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2579.2, "10th_percentile": 2579.2, "90th_percentile": 2579.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2579.2, "10th_percentile": 2579.2, "90th_percentile": 2579.2, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 246.69, "maximum": 4668 } ] }, { "description": "Radiology - Diagnostic - Arthrography", "code_information": [ { "code": "0322", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 4668 } ] }, { "description": "Radiology - Diagnostic - Arteriography", "code_information": [ { "code": "0323", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 4668 } ] }, { "description": "Radiology - Diagnostic - Chest X-Ray", "code_information": [ { "code": "0324", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 4668 } ] }, { "description": "Radiology - Diagnostic - Other", "code_information": [ { "code": "0329", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 4668 } ] }, { "description": "Radiology - Therapeutic - Radiation Therapy", "code_information": [ { "code": "0333", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3205, "methodology": "case rate", "median_amount": 3205, "10th_percentile": 3205, "90th_percentile": 3205, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3113, "methodology": "case rate", "median_amount": 3113, "10th_percentile": 3113, "90th_percentile": 3113, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3113, "methodology": "case rate", "median_amount": 3113, "10th_percentile": 3113, "90th_percentile": 3113, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3113, "methodology": "case rate", "median_amount": 3113, "10th_percentile": 3113, "90th_percentile": 3113, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3113, "methodology": "case rate", "median_amount": 3113, "10th_percentile": 3113, "90th_percentile": 3113, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3113, "methodology": "case rate", "median_amount": 3113, "10th_percentile": 3113, "90th_percentile": 3113, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 55.300000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 3205 } ] }, { "description": "Radiology - Therapeutic - Chemotherapy Administration - IV", "code_information": [ { "code": "0335", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 35.099999999999994, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 1947, "methodology": "case rate", "median_amount": 1947, "10th_percentile": 1947, "90th_percentile": 1947, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_percentage": 38.800000000000004, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 4668, "methodology": "case rate", "median_amount": 4668, "10th_percentile": 4668, "90th_percentile": 4668, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 1519, "methodology": "case rate", "median_amount": 1519, "10th_percentile": 1519, "90th_percentile": 1519, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1519, "maximum": 4668 } ] }, { "description": "Nuclear Medicine - General Classification", "code_information": [ { "code": "0340", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1615, "maximum": 2543.35 } ] }, { "description": "Nuclear Medicine - Diagnostic Procedures", "code_information": [ { "code": "0341", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1352.01, "10th_percentile": 1026.16, "90th_percentile": 1719.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1352.01, "10th_percentile": 1026.16, "90th_percentile": 1719.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1352.01, "10th_percentile": 1026.16, "90th_percentile": 1719.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1352.01, "10th_percentile": 1026.16, "90th_percentile": 1719.47, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "11" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1352.01, "maximum": 2543.35 } ] }, { "description": "Nuclear Medicine - Therapeutic Procedures", "code_information": [ { "code": "0342", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_percentage": 34.4, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 742.39, "10th_percentile": 742.39, "90th_percentile": 742.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 742.39, "10th_percentile": 742.39, "90th_percentile": 742.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 742.39, "10th_percentile": 742.39, "90th_percentile": 742.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 742.39, "10th_percentile": 742.39, "90th_percentile": 742.39, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 1222.76, "10th_percentile": 1222.76, "90th_percentile": 1222.76, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 742.39, "maximum": 2543.35 } ] }, { "description": "Nuclear Medicine - Diagnostic Radiopharmaceuticals", "code_information": [ { "code": "0343", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 775.33, "10th_percentile": 775.33, "90th_percentile": 4105.88, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 775.33, "10th_percentile": 775.33, "90th_percentile": 4105.88, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 775.33, "10th_percentile": 775.33, "90th_percentile": 4105.88, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 775.33, "10th_percentile": 775.33, "90th_percentile": 4105.88, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 775.33, "10th_percentile": 775.33, "90th_percentile": 4105.88, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 1394.47, "10th_percentile": 1113.42, "90th_percentile": 1615, "count": "17" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "median_amount": 775.33, "10th_percentile": 139.57, "90th_percentile": 775.33, "count": "12" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 775.33, "maximum": 2543.35 } ] }, { "description": "Nuclear Medicine - Therapeutic Radiopharmaceuticals", "code_information": [ { "code": "0344", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 3648, "10th_percentile": 3648, "90th_percentile": 3648, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 3648, "10th_percentile": 3648, "90th_percentile": 3648, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 3648, "10th_percentile": 3648, "90th_percentile": 3648, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 3648, "10th_percentile": 3648, "90th_percentile": 3648, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_percentage": 70, "methodology": "percent of total billed charges", "median_amount": 693, "10th_percentile": 693, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 1615, "methodology": "case rate", "median_amount": 1615, "10th_percentile": 1615, "90th_percentile": 1615, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 38.92, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 693, "maximum": 3648 } ] }, { "description": "CT Scan - General Classification", "code_information": [ { "code": "0350", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Commercial", "standard_charge_percentage": 40, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 328, "methodology": "fee schedule", "median_amount": 328, "10th_percentile": 328, "90th_percentile": 328, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 328, "methodology": "fee schedule", "median_amount": 328, "10th_percentile": 328, "90th_percentile": 328, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1779.77, "10th_percentile": 1639.44, "90th_percentile": 2272.52, "count": "108" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1779.77, "10th_percentile": 1639.44, "90th_percentile": 2272.52, "count": "108" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1779.77, "10th_percentile": 1639.44, "90th_percentile": 2272.52, "count": "108" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 1779.77, "10th_percentile": 1639.44, "90th_percentile": 2272.52, "count": "108" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 328, "maximum": 2543.35 } ] }, { "description": "CT Scan - Head Scan", "code_information": [ { "code": "0351", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_dollar": 500, "methodology": "case rate", "median_amount": 500, "10th_percentile": 500, "90th_percentile": 500, "count": "1 through 10" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 328, "methodology": "fee schedule", "median_amount": 328, "10th_percentile": 328, "90th_percentile": 328, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 328, "methodology": "fee schedule", "median_amount": 328, "10th_percentile": 328, "90th_percentile": 328, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 328, "maximum": 2543.35 } ] }, { "description": "CT Scan - Body Scan", "code_information": [ { "code": "0352", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 1171, "methodology": "fee schedule", "median_amount": 1171, "10th_percentile": 1171, "90th_percentile": 1171, "count": "1 through 10" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "St. Vincent IPA", "plan_name": "Medicare Advantage", "standard_charge_percentage": 90, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Bella Vista IPA", "plan_name": "Medicaid - HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Korean American Medical Group", "plan_name": "Korean American Medical Group (Delegated Entity)", "standard_charge_dollar": 500, "methodology": "case rate", "median_amount": 500, "10th_percentile": 500, "90th_percentile": 500, "count": "1 through 10" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 328, "methodology": "fee schedule", "median_amount": 328, "10th_percentile": 328, "90th_percentile": 328, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 328, "methodology": "fee schedule", "median_amount": 328, "10th_percentile": 328, "90th_percentile": 328, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2543.35, "methodology": "case rate", "median_amount": 2543.35, "10th_percentile": 2543.35, "90th_percentile": 2543.35, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2069.05, "methodology": "case rate", "median_amount": 2069.05, "10th_percentile": 2069.05, "90th_percentile": 2069.05, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Accountable IPA", "plan_name": "Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Hispanic IPA", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2256.89, "10th_percentile": 1507.35, "90th_percentile": 2256.89, "count": "45" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2256.89, "10th_percentile": 1507.35, "90th_percentile": 2256.89, "count": "45" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2256.89, "10th_percentile": 1507.35, "90th_percentile": 2256.89, "count": "45" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_percentage": 42.5, "methodology": "percent of total billed charges", "median_amount": 2256.89, "10th_percentile": 1507.35, "90th_percentile": 2256.89, "count": "45" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Commercial", "standard_charge_percentage": 160, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kaiser", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 328, "maximum": 2543.35 } ] }, { "description": "Liletta, 52 mg", "code_information": [ { "code": "J7297", "type": "HCPCS" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" } ], "minimum": 1000, "maximum": 1000 } ] }, { "description": "Mirena, 52 mg", "code_information": [ { "code": "J7298", "type": "HCPCS" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" } ], "minimum": 1000, "maximum": 1000 } ] }, { "description": "Intraut copper contraceptive", "code_information": [ { "code": "J7300", "type": "HCPCS" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" } ], "minimum": 1000, "maximum": 1000 } ] }, { "description": "Skyla, 13.5 mg", "code_information": [ { "code": "J7301", "type": "HCPCS" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" } ], "minimum": 1000, "maximum": 1000 } ] }, { "description": "Etonogestrel implant system", "code_information": [ { "code": "J7307", "type": "HCPCS" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 1000, "methodology": "case rate", "median_amount": 1000, "10th_percentile": 1000, "90th_percentile": 1000, "count": "1 through 10" } ], "minimum": 1000, "maximum": 1000 } ] }, { "description": "Short-stay cases, length of stay is 3 days or fewer- Tier Tier 1", "code_information": [ { "code": "B5001", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Short-stay cases, length of stay is 3 days or fewer- Tier Tier 2", "code_information": [ { "code": "C5001", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Short-stay cases, length of stay is 3 days or fewer- Tier Tier 3", "code_information": [ { "code": "D5001", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF FEMUR", "code_information": [ { "code": "340", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF FEMUR", "code_information": [ { "code": "340", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF FEMUR", "code_information": [ { "code": "340", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF FEMUR", "code_information": [ { "code": "340", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP", "code_information": [ { "code": "341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP", "code_information": [ { "code": "341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP", "code_information": [ { "code": "341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP", "code_information": [ { "code": "341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK", "code_information": [ { "code": "342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 4969.12, "10th_percentile": 4969.12, "90th_percentile": 4969.12, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 4969.12, "maximum": 4969.12 } ] }, { "description": "FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK", "code_information": [ { "code": "342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 5791.33, "10th_percentile": 5791.33, "90th_percentile": 5791.33, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 5791.33, "10th_percentile": 5791.33, "90th_percentile": 6660.03, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 5791.33, "maximum": 5791.33 } ] }, { "description": "FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK", "code_information": [ { "code": "342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK", "code_information": [ { "code": "342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY", "code_information": [ { "code": "343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY", "code_information": [ { "code": "343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 7787.49, "10th_percentile": 7787.49, "90th_percentile": 7787.49, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 7787.49, "maximum": 7787.49 } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY", "code_information": [ { "code": "343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 13198.92, "10th_percentile": 13198.92, "90th_percentile": 13228.62, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 13198.92, "maximum": 13198.92 } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY", "code_information": [ { "code": "343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS", "code_information": [ { "code": "344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 5518.88, "10th_percentile": 5518.88, "90th_percentile": 5518.88, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 5518.88, "maximum": 5518.88 } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS", "code_information": [ { "code": "344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 8571.59, "10th_percentile": 8388.74, "90th_percentile": 13378.05, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 8571.59, "maximum": 8571.59 } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS", "code_information": [ { "code": "344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 12138.81, "10th_percentile": 12138.81, "90th_percentile": 12634.91, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 12138.81, "maximum": 12138.81 } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS", "code_information": [ { "code": "344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS", "code_information": [ { "code": "346", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "median_amount": 5631.52, "10th_percentile": 5631.52, "90th_percentile": 5631.52, "count": "1 through 10" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 5631.52, "maximum": 5631.52 } ] }, { "description": "CONNECTIVE TISSUE DISORDERS", "code_information": [ { "code": "346", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 7210.48, "10th_percentile": 7210.48, "90th_percentile": 7210.48, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 8292.05, "10th_percentile": 8292.05, "90th_percentile": 8292.05, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 7210.48, "maximum": 8292.05 } ] }, { "description": "CONNECTIVE TISSUE DISORDERS", "code_information": [ { "code": "346", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS", "code_information": [ { "code": "346", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES", "code_information": [ { "code": "347", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 5186.66, "10th_percentile": 5186.66, "90th_percentile": 5186.66, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "median_amount": 5394.13, "10th_percentile": 5394.13, "90th_percentile": 5394.13, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 5964.66, "10th_percentile": 5964.66, "90th_percentile": 5964.66, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 5186.66, "maximum": 5964.66 } ] }, { "description": "OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES", "code_information": [ { "code": "347", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 6642.59, "10th_percentile": 6642.59, "90th_percentile": 6642.59, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 8214.89, "10th_percentile": 8214.89, "90th_percentile": 8214.89, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 7557.7, "10th_percentile": 6571.91, "90th_percentile": 7638.98, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 6642.59, "maximum": 8214.89 } ] }, { "description": "OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES", "code_information": [ { "code": "347", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES", "code_information": [ { "code": "347", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE", "code_information": [ { "code": "349", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 4600.83, "10th_percentile": 4600.83, "90th_percentile": 4600.83, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 4600.83, "maximum": 4600.83 } ] }, { "description": "MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE", "code_information": [ { "code": "349", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 7402.47, "10th_percentile": 7402.47, "90th_percentile": 7448.34, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 7402.47, "maximum": 7402.47 } ] }, { "description": "MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE", "code_information": [ { "code": "349", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "median_amount": 14892.04, "10th_percentile": 14892.04, "90th_percentile": 14892.04, "count": "1 through 10" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "median_amount": 9678.88, "10th_percentile": 9678.88, "90th_percentile": 9678.88, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 9678.88, "maximum": 14892.04 } ] }, { "description": "MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE", "code_information": [ { "code": "349", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES", "code_information": [ { "code": "351", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 4215.79, "10th_percentile": 4215.79, "90th_percentile": 4215.79, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 4789.9, "10th_percentile": 4789.9, "90th_percentile": 4848.16, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 4215.79, "maximum": 4789.9 } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES", "code_information": [ { "code": "351", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "median_amount": 5730.82, "10th_percentile": 5730.82, "90th_percentile": 5730.82, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 5510.4, "10th_percentile": 5510.4, "90th_percentile": 5510.4, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "median_amount": 6064.8, "10th_percentile": 5510.4, "90th_percentile": 6336.96, "count": "1 through 10" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 5510.4, "maximum": 6064.8 } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES", "code_information": [ { "code": "351", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES", "code_information": [ { "code": "351", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "median_amount": 17216.98, "10th_percentile": 17216.98, "90th_percentile": 17216.98, "count": "1 through 10" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 17216.98, "maximum": 17216.98 } ] }, { "description": "SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES", "code_information": [ { "code": "361", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES", "code_information": [ { "code": "361", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES", "code_information": [ { "code": "361", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES", "code_information": [ { "code": "361", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "MASTECTOMY PROCEDURES", "code_information": [ { "code": "362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "MASTECTOMY PROCEDURES", "code_information": [ { "code": "362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "MASTECTOMY PROCEDURES", "code_information": [ { "code": "362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "MASTECTOMY PROCEDURES", "code_information": [ { "code": "362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY", "code_information": [ { "code": "363", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY", "code_information": [ { "code": "363", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY", "code_information": [ { "code": "363", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY", "code_information": [ { "code": "363", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES", "code_information": [ { "code": "364", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ] } ] }, { "description": "Health Insurance Prospective Payment System (HIPPS) - Inpatient Rehabilitation Facility", "code_information": [ { "code": "0024", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_dollar": 1850, "methodology": "per diem", "median_amount": 1850, "10th_percentile": 1850, "90th_percentile": 1850, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 1850, "maximum": 1850 } ] }, { "description": "All Inclusive Rate - Room and Board Plus Ancillary", "code_information": [ { "code": "0100", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 850, "methodology": "per diem", "median_amount": 850, "10th_percentile": 850, "90th_percentile": 850, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1839, "methodology": "per diem", "median_amount": 1839, "10th_percentile": 1839, "90th_percentile": 1839, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2825.95, "methodology": "per diem", "median_amount": 2825.95, "10th_percentile": 2825.95, "90th_percentile": 2825.95, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2298.94, "methodology": "per diem", "median_amount": 2298.94, "10th_percentile": 2298.94, "90th_percentile": 2298.94, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 850, "maximum": 16000 } ] }, { "description": "All Inclusive Rate - Room and Board", "code_information": [ { "code": "0101", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 850, "methodology": "per diem", "median_amount": 850, "10th_percentile": 850, "90th_percentile": 850, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1839, "methodology": "per diem", "median_amount": 1839, "10th_percentile": 1839, "90th_percentile": 1839, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2825.95, "methodology": "per diem", "median_amount": 2825.95, "10th_percentile": 2825.95, "90th_percentile": 2825.95, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2298.94, "methodology": "per diem", "median_amount": 2298.94, "10th_percentile": 2298.94, "90th_percentile": 2298.94, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 850, "maximum": 16000 } ] }, { "description": "Room & Board - Private (One Bed) - General Classification", "code_information": [ { "code": "0110", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 850, "methodology": "per diem", "median_amount": 850, "10th_percentile": 850, "90th_percentile": 850, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1839, "methodology": "per diem", "median_amount": 1839, "10th_percentile": 1839, "90th_percentile": 1839, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2825.95, "methodology": "per diem", "median_amount": 2825.95, "10th_percentile": 2825.95, "90th_percentile": 2825.95, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2298.94, "methodology": "per diem", "median_amount": 2298.94, "10th_percentile": 2298.94, "90th_percentile": 2298.94, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 850, "maximum": 16000 } ] }, { "description": "Room & Board - Private (One Bed) - Medical/Surgical/GYN", "code_information": [ { "code": "0111", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 850, "methodology": "per diem", "median_amount": 850, "10th_percentile": 850, "90th_percentile": 850, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Covered California (Qualified Health Plan)", "standard_charge_dollar": 1839, "methodology": "per diem", "median_amount": 1839, "10th_percentile": 1839, "90th_percentile": 1839, "count": "1 through 10" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "median_amount": 2413.62, "10th_percentile": 2413.62, "90th_percentile": 2413.62, "count": "30" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "median_amount": 2413.62, "10th_percentile": 2413.62, "90th_percentile": 2413.62, "count": "30" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Commercial", "standard_charge_dollar": 2825.95, "methodology": "per diem", "median_amount": 2825.95, "10th_percentile": 2825.95, "90th_percentile": 2825.95, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Senior", "standard_charge_dollar": 2298.94, "methodology": "per diem", "median_amount": 2298.94, "10th_percentile": 2298.94, "90th_percentile": 2298.94, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Indemnity", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "PPO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "HMO", "standard_charge_dollar": 3194, "methodology": "per diem", "median_amount": 3194, "10th_percentile": 3194, "90th_percentile": 3194, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 850, "maximum": 16000 } ] }, { "description": "Room & Board - Private (One Bed) - Obstetrics (OB)", "code_information": [ { "code": "0112", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Cal Optima", "plan_name": "Medi-Cal", "standard_charge_dollar": 300, "methodology": "per diem", "median_amount": 300, "10th_percentile": 300, "90th_percentile": 300, "count": "1 through 10" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "AltaMed", "plan_name": "Medi-Cal", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Commercial", "standard_charge_dollar": 2250, "methodology": "per diem", "median_amount": 2250, "10th_percentile": 2250, "90th_percentile": 2250, "count": "1 through 10" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medicare and Medi-Cal (Dual-Eligibles)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Centinela Hospital Medical Center", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pacific Pace", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" } ], "minimum": 300, "maximum": 16000 } ] }, { "description": "Room & Board - Private (One Bed) - Pediatric", "code_information": [ { "code": "0113", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "All Other Commercial Products", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Open Access", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Network", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "HMO", "standard_charge_dollar": 3033, "methodology": "per diem", "median_amount": 3033, "10th_percentile": 3033, "90th_percentile": 3033, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medi-Cal", "standard_charge_dollar": 1512.5, "methodology": "per diem", "median_amount": 1512.5, "10th_percentile": 1512.5, "90th_percentile": 1512.5, "count": "1 through 10" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Special Needs Plan (SNP)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Easy Choice, dba WellCare of California", "plan_name": "Medicare Advantage Prescription Drug (MAPD)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "DSNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "HMO Salud Con Benefit Program", "standard_charge_dollar": 10640, "methodology": "case rate", "median_amount": 10640, "10th_percentile": 10640, "90th_percentile": 10640, "count": "1 through 10" }, { "payer_name": "Brand New Day", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Aetna", "plan_name": "POS", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "PPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "EPO", "standard_charge_dollar": 2640, "methodology": "per diem", "median_amount": 2640, "10th_percentile": 2640, "90th_percentile": 2640, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Brand New Day", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medi-Cal Two-Plan Model", "standard_charge_percentage": 110.00000000000001, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Astiva Healthcare", "plan_name": "C-SNP (Chronic Special Needs Plan)", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Commercial - All Payer", "standard_charge_dollar": 3155, "methodology": "per diem", "median_amount": 3155, "10th_percentile": 3155, "90th_percentile": 3155, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicaid", "plan_name": "Medicaid", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Network PFFS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare POS", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare PPO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "K-Day", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Medi-Cal", "standard_charge_percentage": 104, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Imperial Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "California State Prison", "plan_name": "Prison Healthcare Provider Network Project", "standard_charge_percentage": 125, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "MA-SNP", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Interplan", "plan_name": "Commercial", "standard_charge_percentage": 75, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "HMO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Senior HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Commercial", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "Health Net of California", "plan_name": "Enhanced PPO", "standard_charge_dollar": 16000, "methodology": "case rate", "median_amount": 16000, "10th_percentile": 16000, "90th_percentile": 16000, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Health Benefit Exchange", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Kern Health Systems", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Valley Presbyterian Medical Center", "plan_name": "Medi-Cal", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Pipeline formerly Avanti", "plan_name": "Medi-Cal", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam Department of Public Health and Human Services", "plan_name": "Medically Indigent Program (MIP)", "standard_charge_percentage": 55.00000000000001, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Access Senior Healthcare", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Tailored Network", "standard_charge_dollar": 2950, "methodology": "per diem", "median_amount": 2950, "10th_percentile": 2950, "90th_percentile": 2950, "count": "1 through 10" }, { "payer_name": "LA Care", "plan_name": "Medi-Cal", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Self Funded Plans", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "High Deductible Health Plan (HDHP)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Point of Service (POS)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Preferred Provider Organization (PPO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "NetCare", "plan_name": "Health Maintenance Organization (HMO)", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AHMC", "plan_name": "Self-Funded EPO/PPO", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Bronze", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell 7030", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold 12", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Gold", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Guam StayWell", "plan_name": "StayWell Silver", "standard_charge_percentage": 45, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alignment", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Asian Heritage PACE", "plan_name": "Duals", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Health Net of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "Commercial", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "New Century Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Blue Shield of California", "plan_name": "EPN Network", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SCAN", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medicare Advantage", "standard_charge_percentage": 106, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Central Health Plan of California", "plan_name": "Commercial", "standard_charge_percentage": 130, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "PASC-SEIU", "standard_charge_percentage": 120, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Anthem", "plan_name": "Medi-Cal Managed Care", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered California", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "SelectCare", "plan_name": "Commercial", "standard_charge_percentage": 43, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial POS", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "TakeCare", "plan_name": "Commercial PPO", "standard_charge_percentage": 50, "methodology": "percent of total billed charges", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Medicare Advantage", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Alta Hospital Systems", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Optum", "plan_name": "Commercial HMO/POS", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Optum", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2989, "methodology": "per diem", "median_amount": 2989, "10th_percentile": 2989, "90th_percentile": 2989, "count": "1 through 10" }, { "payer_name": "Clever Care Health", "plan_name": "Medicare Advantage HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select Plus", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Select", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Navigate", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "Core", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "UnitedHealthcare of California", "plan_name": "HMO", "standard_charge_dollar": 3011, "methodology": "per diem", "median_amount": 3011, "10th_percentile": 3011, "90th_percentile": 3011, "count": "1 through 10" }, { "payer_name": "Heritage Provider Network", "plan_name": "Molina Healthcare Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "L.A. Care Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Heritage Provider Network", "plan_name": "Health Net Medi-Cal HMO", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "Rios Health Plan", "plan_name": "Medicare Advantage", "standard_charge_percentage": 105, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "AltaMed", "plan_name": "PACE", "standard_charge_percentage": 100, "methodology": "fee schedule", "additional_payer_notes": "No claims data available for the lookback period", "count": "0" }, { "payer_name": "LA Care", "plan_name": "L.A. Care Covered Direct", "standard_charge_percentage": 114.99999999999999, "methodology": "fee schedule",