{ "hospital_name": "Saint Marys Regional Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Saint Marys Regional Medical Center" ], "hospital_address": [ "235 West Sixth Street Reno, NV 89503" ], "license_information": { "license_number": "454989022", "state": "NV" }, "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": "Derrick Glum" }, "type_2_npi": [ "1801152566", "1114430311", "1851658025" ], "standard_charge_information": [ { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4200.83, "minimum": 420.083, "maximum": 4200.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Acellular derm matrix implt", "code_information": [ { "code": "15777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3589.47, "minimum": 252.0, "maximum": 3589.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8803.0, "minimum": 8327.1293, "maximum": 17912.23, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15670.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8979.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11445.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12325.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16287.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12325.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14086.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13954.18, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 14113.0 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17912.23 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10124.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10124.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12765.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13646.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8788.88 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9068.02, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17456.0, "minimum": 15510.8205, "maximum": 37260.73, "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25311.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 27057.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20777.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17979.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31071.95, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17805.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26184.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 29151.77, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 22693.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17456.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 24438.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32293.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26184.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26184.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 24438.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27929.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27668.08, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 29357.64 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 37260.73 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26184.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 20074.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 20074.63, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7514.0, "minimum": 4722.89, "maximum": 34987.6301, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13375.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7664.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11271.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9768.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10520.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13901.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11271.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11271.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10520.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12023.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11910.59, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11841.3 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15028.98 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11271.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8641.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8641.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10896.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11647.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4722.89 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7514.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7740.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10535.0, "minimum": 10535.79, "maximum": 68466.0793, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18753.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10746.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15803.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 17594.77, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13696.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10535.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14750.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19491.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15803.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15803.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14750.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16857.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16699.24, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 17164.46 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 21785.15 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15803.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12116.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12116.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 15276.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 16330.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10535.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14522.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10535.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10851.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8220.0, "minimum": 8220.74, "maximum": 18295.4338, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14632.92, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8385.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12331.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13728.64, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10686.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11509.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15208.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12331.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12331.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11509.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13153.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13029.87, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13085.53 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 16608.16 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12331.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9453.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9453.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11920.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12742.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11188.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8467.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8464.0, "minimum": 4354.0, "maximum": 17153.01, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15066.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8633.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12696.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 14135.53, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11003.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11850.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15659.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12696.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12696.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11850.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13543.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13416.06, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13514.82 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17153.01 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12696.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9734.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9734.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12273.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13119.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6763.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8464.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8718.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14429.0, "minimum": 7929.14, "maximum": 30492.06, "payers_information": [ { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16593.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20922.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 22365.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7929.14 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14862.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25684.23, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14717.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21644.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 24097.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18758.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14429.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 20201.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26694.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21644.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21643.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 20201.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23086.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22870.44, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 24024.62 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 30492.06 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21644.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16593.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6570.0, "minimum": 6570.34, "maximum": 28228.3808, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11695.21, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6701.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9855.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10972.47, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8541.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12155.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9855.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9855.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9198.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10512.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10413.99, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10177.63 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12917.46 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9855.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7555.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7555.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9526.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10184.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9484.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6570.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6767.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13608.0, "minimum": 11690.0329, "maximum": 28655.64, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24222.47, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13880.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20412.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22725.58, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17690.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13608.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19051.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25175.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20412.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20412.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19051.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21773.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21568.84, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22577.71 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 28655.64 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20412.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15649.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15649.32, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19731.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21092.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15685.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13608.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14016.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22412.0, "minimum": 21710.0611, "maximum": 48343.56, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 39893.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 22860.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 33618.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 37428.31, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 29135.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 22412.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 31377.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 41462.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33618.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 33618.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 31377.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35859.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 35523.34, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 38089.77 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 48343.56 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 33618.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 25773.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 25774.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 32497.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 34738.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22412.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30785.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 22412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 23084.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44649.0, "minimum": 26529.2902, "maximum": 98071.57, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 79476.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 45542.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 66974.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 74564.65, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 58044.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44649.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 62509.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 82601.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 66974.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 66974.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 62509.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 71439.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 70769.46, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 77270.34 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 98071.57 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 66974.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 51346.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 51346.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 64741.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 69206.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44649.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 93763.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44649.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 45988.97, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10297.0, "minimum": 7983.7163, "maximum": 25398.8, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15446.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11842.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11842.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14931.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15961.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25398.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10606.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18329.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10503.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15446.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 17197.21, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13387.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10297.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14416.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19050.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15446.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15446.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14416.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16476.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16321.85, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16745.03 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 21252.8 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16617.0, "minimum": 8804.0918, "maximum": 35385.01, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29578.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16949.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24926.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 27750.99, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21602.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16617.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 23264.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30742.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24926.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24926.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 23264.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26587.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26338.58, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 27879.76 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 35385.01 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24926.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 19109.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 19110.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 24095.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25756.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29114.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16617.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17115.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7071.0, "minimum": 3187.71, "maximum": 14037.53, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12586.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7212.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10606.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11808.92, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9192.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9899.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13081.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10606.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10606.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9899.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11313.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11207.87, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11060.14 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14037.53 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10606.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8131.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8131.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10253.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10960.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3187.71 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7071.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7283.35, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10086.0, "minimum": 4971.03, "maximum": 20781.19, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17954.58, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10288.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15130.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 16845.02, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13112.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10086.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14121.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18660.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15130.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14121.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16138.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15987.58, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16373.45 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 20781.19 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15130.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11599.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11599.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14625.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15634.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10086.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4971.03 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10086.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10389.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9789.0, "minimum": 9789.67, "maximum": 20116.65, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17425.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9985.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14684.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 16348.75, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12726.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18110.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14684.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14684.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13705.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15663.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15516.63, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 15849.86 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 20116.65 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14684.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11258.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11258.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14195.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15173.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16059.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9789.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10083.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6323.0, "minimum": 6323.5, "maximum": 12365.46, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11255.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6449.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9485.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10560.25, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8220.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8852.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11698.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9485.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9485.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8852.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10022.75, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9742.72 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12365.46 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9485.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7272.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7272.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9169.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9801.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8468.66 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6513.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8136.0, "minimum": 8136.07, "maximum": 16418.8, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14482.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8298.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12204.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13587.24, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10576.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11390.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15051.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12204.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11390.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13017.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12895.67, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12936.33 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 16418.8 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12204.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9356.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9356.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11797.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12610.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10574.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8136.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8380.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15691.0, "minimum": 14322.8659, "maximum": 33314.57, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27930.89, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16005.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23537.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 26204.82, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 20398.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15691.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 21968.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29029.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23537.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23537.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 21968.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25106.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24871.03, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 26248.47 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 33314.57 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23537.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18045.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18045.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 22752.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 24321.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21215.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16162.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11972.0, "minimum": 11972.1, "maximum": 49698.9374, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21310.34, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12211.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17958.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 19993.41, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15563.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16760.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22148.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17958.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17958.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16760.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19155.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18975.78, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 19695.15 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 24997.1 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17958.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13767.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13767.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17359.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18556.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16975.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11972.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12331.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5578.0, "minimum": 5578.18, "maximum": 31534.6128, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 9929.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5689.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8367.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9315.56, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7251.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 7809.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10319.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8367.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8367.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 7809.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8925.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 8841.42, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 8429.52 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 10698.75 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8367.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6414.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6414.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8088.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 8646.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6416.62 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5578.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 5745.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18302.0, "minimum": 17797.6967, "maximum": 39154.32, "payers_information": [ { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29284.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 29010.1, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 30849.59 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 39154.32 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 27454.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 21048.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 21048.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 26539.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 28369.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27992.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 18852.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32579.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 18668.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27454.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 30565.88, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 23793.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18302.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 25624.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 33860.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27454.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27454.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 25624.09, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29697.0, "minimum": 29697.59, "maximum": 87335.8284, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 52861.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 30291.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 44546.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 49594.98, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 38606.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 29697.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 41576.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 54940.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44546.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 44546.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 41576.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 47516.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 47070.7, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 50926.17 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 64635.52 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 44546.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 34152.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 34152.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 43061.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 46031.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40769.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 29697.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 30588.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12102.0, "minimum": 7578.04, "maximum": 25288.28, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21542.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12344.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18153.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 20210.86, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15733.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12102.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16943.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22389.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18153.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18153.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16943.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19363.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19182.15, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 19924.57 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 25288.28 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18153.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13917.66, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13917.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17548.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18758.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7578.04 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12465.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37240.0, "minimum": 9971.0, "maximum": 81502.71, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 66287.63, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 72589.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 37985.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 55860.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 62191.2, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 48412.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 37240.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 51905.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 52136.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 68894.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 55860.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 55860.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 52136.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 59584.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 59025.72, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 64215.78 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 81502.71 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 55860.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 42826.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 42826.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45704.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 51905.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 60368.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 53998.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 57722.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37240.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55849.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 37240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 38357.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14734.0, "minimum": 7464.0, "maximum": 31174.47, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26227.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 15029.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22101.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 24606.6, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 19154.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14734.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 20628.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27258.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22101.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22101.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 20628.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23575.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23354.18, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 24562.28 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 31174.47 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 22101.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16944.66, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16944.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 21365.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 22838.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14734.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12070.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 15176.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11853.0, "minimum": 11853.07, "maximum": 45500.5928, "payers_information": [ { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16594.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21928.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17779.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17779.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16594.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18964.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18787.16, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 19485.43 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 24730.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17779.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13631.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13631.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17186.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18372.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17256.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12208.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21098.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12090.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17779.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 19794.63, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15408.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11853.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 5131.5, "maximum": 15770.34, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13966.04, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8003.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11769.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13102.97, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10199.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10984.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14515.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11769.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11769.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10984.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12553.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12436.05, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12425.41 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15770.34 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11769.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9023.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9023.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11376.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12161.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7846.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8081.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5808.0, "minimum": 5808.24, "maximum": 20277.4, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10338.67, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5924.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8712.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9699.76, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7550.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8131.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10745.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8712.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8712.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8131.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9293.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9206.06, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 8834.88 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11213.23 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8712.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6679.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6679.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8421.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9002.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20277.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5808.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 5982.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5721.0, "minimum": 3265.5, "maximum": 11020.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10185.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5836.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8582.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9555.69, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7438.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10585.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8582.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8010.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9155.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9069.32, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 8682.87 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11020.3 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8582.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6580.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6580.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8296.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 8869.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3972.29 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5721.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 5893.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7748.0, "minimum": 7598.63, "maximum": 21725.6495, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13792.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7903.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11622.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12940.21, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10073.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10848.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14334.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11622.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11622.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10848.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12397.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12281.58, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12253.7 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15552.4 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11622.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8910.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8910.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11235.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12010.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7598.63 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7748.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7981.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14227.0, "minimum": 8474.6697, "maximum": 30040.1, "payers_information": [ { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14227.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19918.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26320.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21340.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21340.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19918.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22763.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22550.11, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 23668.52 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 30040.1 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21340.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16361.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16361.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20629.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 22052.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15854.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14654.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25324.47, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14511.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21340.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 23759.47, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18495.4, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7215.0, "minimum": 7215.8, "maximum": 20304.8248, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12844.12, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7360.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10823.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12050.39, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9380.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13349.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10823.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10823.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10102.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11545.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11437.04, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11314.89 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14360.87 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10823.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8298.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8298.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10462.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11184.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10287.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7215.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7432.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6116.0, "minimum": 4547.85, "maximum": 22351.2684, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10887.55, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6238.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9174.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10214.72, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7951.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11315.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9174.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9174.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8563.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9786.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9694.81, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9378.17 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11902.78 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9174.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7034.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7034.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8869.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9480.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4547.85 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6116.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6300.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29891 - ", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5292.31, "discounted_cash": 3559.0, "minimum": 667.61, "maximum": 5292.31, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.61 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5292.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 96797.0, "minimum": 96797.8, "maximum": 214687.77, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 172300.14, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 98733.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 145196.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 161652.38, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 125837.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 96797.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 135516.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 179075.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 145196.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 145196.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 135516.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 154876.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 153424.51, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 169151.94 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 214687.77 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 145196.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 111317.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 111317.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 140356.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 150036.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 96797.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 120932.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 96797.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 99701.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29897 - ", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6880.06, "discounted_cash": 3559.0, "minimum": 497.3, "maximum": 6880.06, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6880.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6880.06, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 497.3 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6880.06, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6880.06, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6880.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Alcohol Absolute Inj 98%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "17478050305", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Amiodarone Hcl Inj 900 Mg/18Ml (50 Mg/Ml)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00143987501", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 3.3, "10th_percentile": 3.3, "90th_percentile": 3.3, "count": "1 through 10" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34530.0, "minimum": 7062.19, "maximum": 75443.24, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 61464.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 35221.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 51795.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 57666.05, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 44889.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34530.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 48342.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 63881.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 51795.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 51795.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 48342.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 55248.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 54731.0, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 59441.54 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 75443.24 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 51795.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 39710.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 39710.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 50069.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 53522.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34530.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7062.19 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34530.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 35566.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10725.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 19308.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 10725.0 } ] } ] }, { "description": "Ampicillin Sodium For Inj 500 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340795", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" } ] } ] }, { "description": "Ampicillin Sodium For Inj 125 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340095", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40110.0, "minimum": 36255.5095, "maximum": 87921.25, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 71396.65, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 40912.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 60165.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 66984.5, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 52143.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 40110.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 56154.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 74204.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 60165.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 60165.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 56154.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 64176.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 63575.14, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 69272.93 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 87921.25 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 60165.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 46127.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 46127.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 58160.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 62171.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40110.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40746.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 40110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 41313.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ampicillin Sodium For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409372001", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" } ] } ] }, { "description": "Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3559.0, "minimum": 546.72, "maximum": 8430.55, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 623.26 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" } ] } ] }, { "description": "Arthrt Elbw Expl Drg/Rmvl Fb", "code_information": [ { "code": "24000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3559.0, "minimum": 461.57, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.57 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Ampicillin Sodium For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "67457035101", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" } ] } ] }, { "description": "Ampicillin Sodium For Inj 250 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340295", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15734.0, "minimum": 15651.3, "maximum": 33411.04, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 28007.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16049.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23601.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 26276.85, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 20455.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15734.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 22028.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29109.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23601.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23601.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 22028.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25175.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24939.34, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 26324.47 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 33411.04 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23601.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18094.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18094.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 22815.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 24388.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15734.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15651.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15734.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16206.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ascorbic Acid Inj 500 Mg/Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "67157010150", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Amputate Metacarpal Bone", "code_information": [ { "code": "26910", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10116.7, "discounted_cash": 3559.0, "minimum": 684.57, "maximum": 10116.7, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 684.57 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23564.0, "minimum": 17608.1836, "maximum": 50921.33, "payers_information": [ { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 30634.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 23564.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 32990.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 43595.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35347.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 35347.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 32990.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37703.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 37350.37, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 40120.79 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 50921.33 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 35347.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 27099.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 27099.64, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 34169.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 36525.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21457.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 24271.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 41945.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 24036.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 35347.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 39353.35, "additional_payer_notes": "167.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12123.0, "minimum": 12123.88, "maximum": 41148.3374, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21580.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12366.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18185.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 20246.88, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15761.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12123.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16973.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22429.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18185.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18185.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16973.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19398.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19216.38, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 19962.57 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 25336.51 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18185.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13942.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13942.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17579.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18792.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12123.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14230.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12487.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6171.0, "minimum": 5364.34, "maximum": 22456.7258, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10985.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6295.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9257.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10306.77, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8023.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8640.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11417.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9257.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9257.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8640.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9874.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9782.18, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9475.29 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12026.04 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9257.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7097.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7097.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8948.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9566.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5364.34 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6171.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6356.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18973.0, "minimum": 18973.1, "maximum": 40653.1, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 33772.19, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 19352.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28459.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 31685.14, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 24665.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18973.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 26562.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 35100.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28459.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28459.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 26562.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30357.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30072.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 32030.48 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 40653.1 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 28459.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 21819.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 21819.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 27511.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 29408.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18973.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21528.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 19542.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28652.0, "minimum": 23788.3457, "maximum": 62298.91, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 51001.81, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 29225.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 42979.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 47850.01, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 37248.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 40113.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 53007.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42979.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 42979.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 40113.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 45844.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 45414.53, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 49085.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 62298.91 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 42979.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 32950.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 32950.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 41546.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 44411.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25280.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 28652.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 29512.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Toe & Metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3559.0, "minimum": 425.55, "maximum": 10961.3, "payers_information": [ { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 425.55 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Av Fuse Uppr Arm Basilic", "code_information": [ { "code": "36819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27119.3, "discounted_cash": 6052.0, "minimum": 729.63, "maximum": 27119.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1425.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10994.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11670.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3635.8 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13134.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 729.63 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11245.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12870.83, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13739.38, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9986.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10592.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3733.97 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35087.0, "minimum": 35087.37, "maximum": 76688.37, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 62455.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 35789.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 52631.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 58595.91, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 45613.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 35087.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 49122.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 64911.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 52631.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 52631.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 49122.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 56139.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 55613.53, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 60422.57 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 76688.37 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 52631.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 40350.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 40350.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 50876.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 54385.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35087.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59392.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 35087.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 36139.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3559.0, "minimum": 388.99, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 388.99 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19132.0, "minimum": 11073.1614, "maximum": 41008.6, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 34055.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 19514.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28698.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 31950.62, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 24871.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19132.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 35394.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28698.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28698.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 26784.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30611.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30324.38, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 32310.57 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 41008.6 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 28698.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 22001.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 22001.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 27741.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 29654.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19132.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27049.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19132.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 19706.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Av Fusion Direct Any Site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18485.2, "discounted_cash": 3434.0, "minimum": 687.21, "maximum": 18485.2, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 844.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6238.66, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6622.29, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7452.73, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7734", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21389.37, "10th_percentile": 21389.37, "90th_percentile": 21389.37, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 687.21 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6381.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7303.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7796.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5666.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6010.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3537.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4293.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10221.0, "minimum": 8858.88, "maximum": 21083.09, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18194.88, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10426.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15332.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 17070.47, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13288.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10221.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14310.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18910.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15332.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15332.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14310.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16354.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16201.55, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16611.32 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 21083.09 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15332.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11755.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11755.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14821.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15843.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8858.88 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10221.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10528.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6400.0, "minimum": 6400.98, "maximum": 29716.1852, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11393.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6529.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9601.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10689.64, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8321.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8961.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11841.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9601.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9601.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8961.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10241.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10145.55, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9879.24 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12538.74 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9601.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7361.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7361.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9281.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9921.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6797.58 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6400.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6593.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6300.19, "discounted_cash": 3559.0, "minimum": 248.82, "maximum": 6300.19, "payers_information": [ { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.9 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 725.12 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.9 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 248.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6300.19, "additional_payer_notes": "192.82% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55737.0, "minimum": 15536.0, "maximum": 122866.81, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 99212.59, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 56852.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 83606.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 93081.47, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 72458.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 55737.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 78032.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 103114.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 83606.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 83606.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 78032.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 89179.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 88343.78, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 96806.44 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 122866.81 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 83606.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 64098.02, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 64098.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 80819.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 86392.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55737.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15536.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 55737.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 57409.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 23986.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 43179.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 23986.0 } ] } ] }, { "description": "Anoscopy", "code_information": [ { "code": "46615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3019.0, "minimum": 91.14, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 624.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3079.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5484.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5821.49, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6551.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5585.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.14 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5609.54, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6420.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6853.43, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4981.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5283.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3109.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3773.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11249.0, "minimum": 11249.15, "maximum": 35512.0669, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20023.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11474.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16873.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 18786.08, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14623.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11249.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 15748.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20810.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16873.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16873.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 15748.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17998.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17829.98, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 18421.36 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 23380.4 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16873.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12936.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12936.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16311.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 17436.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13836.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11249.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11586.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 7041.0, "minimum": 618.68, "maximum": 8430.55, "payers_information": [ { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1154.72 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 618.68 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 8097.94, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 8097.94, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1154.72 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1154.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 7252.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 981.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7182.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7041.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1154.72 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12727.0, "minimum": 6610.0, "maximum": 40903.2202, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22655.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12982.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19091.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 21255.44, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 16546.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12727.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 17818.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23546.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19091.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19091.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 17818.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20364.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20173.56, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 21026.64 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 26687.03 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19091.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 14636.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 14636.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 18455.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 19728.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17976.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13109.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6610.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 11898.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 6610.0 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12885.0, "minimum": 12885.18, "maximum": 27038.95, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22935.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13142.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19327.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 21518.25, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 16750.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18039.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23837.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19327.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19327.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18039.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20616.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20423.04, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 21303.92 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 27038.95 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19327.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 14817.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 14817.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 18683.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 19972.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26927.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13271.74, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21397.0, "minimum": 21397.6, "maximum": 46074.83, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38087.78, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 21825.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32096.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 35734.04, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 27816.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21397.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 29956.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 39585.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32096.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32096.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 29956.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34236.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 33915.2, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 36302.24 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 46074.83 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 32096.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 24607.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 24607.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 31026.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 33166.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26225.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 22039.56, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29898 - ", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4891.53, "discounted_cash": 3559.0, "minimum": 549.07, "maximum": 4891.53, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.07 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4891.53, "additional_payer_notes": "227.00% of Medicare Rates" } ] } ] }, { "description": "Anoscopy And Biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11761.6, "discounted_cash": 1301.0, "minimum": 25.83, "maximum": 11761.6, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2603.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1327.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2364.36, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.79 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2509.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1952.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2824.47, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1822.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.79 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2407.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1952.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.27 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1822.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2418.37, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2767.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2954.63, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2603.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1496.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1496.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2147.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2277.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.79 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1340.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1627.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Anterior Colporrhaphy", "code_information": [ { "code": "57240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12331.3, "discounted_cash": 5441.0, "minimum": 650.45, "maximum": 12331.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1215.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5550.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10491.82, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 11807.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10066.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 650.45 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10109.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 11570.82, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12331.3, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8978.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 9522.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5604.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 6801.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 } ] } ] }, { "description": "Arginine Hcl Inj 10%", "drug_information": { "unit": 300.0, "type": "ML" }, "code_information": [ { "code": "00009043601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Artery-Vein Autograft", "code_information": [ { "code": "36825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30127.5, "discounted_cash": 6052.0, "minimum": 789.08, "maximum": 30127.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1425.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10994.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11670.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13134.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 789.08 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11245.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12870.83, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13739.38, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9986.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10592.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19925.0, "minimum": 19925.36, "maximum": 42782.49, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 35467.14, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 20323.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29888.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 33275.35, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 25902.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19925.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 27895.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 36861.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29888.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29888.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 27895.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31880.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 31581.76, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 33708.22 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 42782.49 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 29888.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 22914.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 22914.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 28891.77, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 30884.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19925.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29946.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 20523.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Artery-Vein Nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25315.7, "discounted_cash": 6052.0, "minimum": 650.92, "maximum": 25315.7, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1425.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10994.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11670.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13134.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 650.92 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11245.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12870.83, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13739.38, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9986.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10592.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Arthrd Si Jt Perq/Min Nvas", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18727.5, "discounted_cash": 19071.0, "minimum": 3230.0, "maximum": 18727.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 5298.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3635.8 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5755.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3752.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 5755.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3733.97 } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9938.0, "minimum": 9938.25, "maximum": 20448.92, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17690.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10137.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14907.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 16596.88, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12919.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18385.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14907.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14907.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13913.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15901.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15752.13, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16111.65 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 20448.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14907.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11428.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11428.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14410.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15404.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17320.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9938.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10236.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Wrist With Autograft", "code_information": [ { "code": "25825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18727.5, "discounted_cash": 7892.0, "minimum": 730.79, "maximum": 18727.5, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1670.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14337.11, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15218.72, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 17127.18, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14601.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 730.79 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14664.66, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 16783.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 17916.45, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13022.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13812.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8129.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9865.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Si Jt Prq Wo Tfxj Dev", "code_information": [ { "code": "27278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18727.5, "discounted_cash": 19071.0, "minimum": 3230.0, "maximum": 18727.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 6950.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 8177.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 8177.24 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 8177.24 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8177.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5755.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3752.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 5755.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 18727.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44913.0, "minimum": 22675.0, "maximum": 98662.87, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 79946.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 45812.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 67370.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 75006.23, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 58388.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44913.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 62879.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 83090.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 67370.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 67370.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 62879.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 71862.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 71188.53, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 77736.23 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 98662.87 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 67370.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 51651.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 51650.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 65125.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 69616.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44913.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70134.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 46261.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 22675.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 40820.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 22675.0 } ] } ] }, { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3559.0, "minimum": 798.03, "maximum": 10961.3, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 798.03 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20076.6, "maximum": 43045.1455, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20076.6 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13477.0, "minimum": 13477.1, "maximum": 28362.67, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23989.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13746.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20215.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22506.79, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17520.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13477.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18867.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24932.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20215.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20215.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18867.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21563.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21361.2, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22346.88 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 28362.67 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20215.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15498.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15498.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19541.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 20889.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13477.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21343.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13477.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13881.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthro/shoul surg; w/spacer", "code_information": [ { "code": "C9781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5645.39, "discounted_cash": 13964.0, "minimum": 1693.617, "maximum": 5645.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 4503.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5645.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10352.0, "minimum": 9604.1169, "maximum": 21376.06, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18428.07, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10559.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15529.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 17289.26, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13458.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10352.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14494.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19152.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15529.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15529.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14493.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16564.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16409.35, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16842.15 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 21376.06 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15529.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11905.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11905.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 15011.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 16046.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10352.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13295.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10663.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthrp ntrcrpl/crp/mtcrp ssp", "code_information": [ { "code": "25448", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8094.53, "discounted_cash": 3559.0, "minimum": 411.92, "maximum": 8094.53, "payers_information": [ { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 411.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 881.07 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 } ] } ] }, { "description": "BIOPSY OF CERVIX", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3228.39, "discounted_cash": 1001.0, "minimum": 25.57, "maximum": 3228.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 25.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1021.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1819.84, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1931.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3228.39 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2173.99, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1853.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.52 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1861.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2130.41, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2274.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3228.39 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1653.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1753.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3228.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1031.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1252.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3228.39 } ] } ] }, { "description": "Arthrp W/Prostc Trapezium", "code_information": [ { "code": "25445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13027.4, "discounted_cash": 7892.0, "minimum": 694.89, "maximum": 13027.4, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1670.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 694.89 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13022.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13027.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8129.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9865.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 } ] } ] }, { "description": "Biopsy Of Rectum", "code_information": [ { "code": "45100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10117.7, "discounted_cash": 3019.0, "minimum": 291.33, "maximum": 10117.7, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 624.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3079.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5484.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5821.49, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6551.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5585.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.33 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5609.54, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6420.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6853.43, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4981.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5283.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3109.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3773.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48162.0, "minimum": 48162.79, "maximum": 105928.16, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 85729.77, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 49126.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 72244.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 80431.86, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 62611.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 48162.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 67427.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 89101.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 72244.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 72244.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 67427.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 77060.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 76338.04, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 83460.53 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 105928.16 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 72244.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 55387.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 55387.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 69836.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 74652.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48162.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51717.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 48162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 49607.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44189.0, "minimum": 44189.36, "maximum": 97042.61, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 78657.06, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 45073.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 66284.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 73796.23, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 57446.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44189.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 61865.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 81750.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 66284.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 66284.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 61865.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 70702.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 70040.2, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 76459.62 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 97042.61 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 66284.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 50817.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 50817.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 64074.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 68493.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44189.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68982.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 45515.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11149.0, "minimum": 10558.0419, "maximum": 23157.1, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19845.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11372.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16723.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 18619.33, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14494.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20626.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16723.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16723.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 15609.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17838.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17671.64, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 18245.42 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 23157.1 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16723.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12821.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12821.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16166.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 17281.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14926.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11149.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11483.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323040201", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Av Fistula Revision", "code_information": [ { "code": "36833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18547.2, "discounted_cash": 6052.0, "minimum": 650.64, "maximum": 18547.2, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1425.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10994.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11670.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13134.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 650.64 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11245.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12870.83, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13739.38, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9986.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10592.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Breast Augmentation W/Implt", "code_information": [ { "code": "19325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13153.1, "discounted_cash": 8890.0, "minimum": 631.0, "maximum": 13153.1, "payers_information": [ { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 10223.88, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 2479.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2479.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 9157.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 11112.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3733.97 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 2107.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5368.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9068.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 2479.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3635.8 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 12446.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 2479.53 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12446.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 631.0 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 12446.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13153.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 10223.88, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8890.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323040120", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Av Fistula Revision Open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16197.5, "discounted_cash": 6052.0, "minimum": 573.89, "maximum": 16197.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1425.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10994.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11670.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13134.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 573.89 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11245.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12870.83, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13739.38, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9986.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10592.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6146.0, "minimum": 4868.07, "maximum": 13411.6161, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10940.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6269.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9219.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10264.07, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7990.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11370.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9219.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9219.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8604.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9833.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9741.65, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9430.25 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11968.88 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9219.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7068.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7068.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8911.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9526.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4868.07 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6146.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6330.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17372.0, "minimum": 7153.0, "maximum": 37073.16, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 30922.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17719.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26058.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 29011.69, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 22583.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17372.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 24321.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32138.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26058.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26058.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 24321.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27795.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27535.1, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 29209.85 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 37073.16 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26058.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 19978.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 19978.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25189.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 26927.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17372.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12640.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17372.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17893.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16772.0, "minimum": 6610.0, "maximum": 35731.57, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25997.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22945.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17275.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6610.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 11898.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 6610.0 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29854.77, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17107.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 25158.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 28009.81, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21804.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16772.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 23481.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 31028.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25158.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25158.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 23481.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26835.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26584.1, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 28152.82 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 35731.57 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 25158.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 19288.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 19288.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 24319.89, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "Av Fuse Uppr Arm Cephalic", "code_information": [ { "code": "36818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21577.5, "discounted_cash": 6052.0, "minimum": 844.3, "maximum": 21577.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 844.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10994.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11670.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13134.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11245.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12870.83, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13739.38, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9986.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10592.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.5%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "55150025050", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28908.0, "minimum": 28908.3, "maximum": 62870.56, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 51456.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 29486.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 43362.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 48276.91, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 37580.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 28908.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 40471.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 53480.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43362.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 43362.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 40471.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 46253.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 45819.66, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 49535.56 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 62870.56 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 43362.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 33244.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 33244.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 41917.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 44807.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28908.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33975.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 28908.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 29775.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "63323046201", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20439.0, "minimum": 20439.0, "maximum": 43931.15, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 36381.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 20847.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30658.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 34133.16, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 26570.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20439.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 28614.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 37812.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30658.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30658.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 28614.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32702.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 32395.82, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 34613.24 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 43931.15 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30658.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 23504.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 23504.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 29636.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 31680.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20439.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20522.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 21052.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21397.0, "minimum": 17328.3656, "maximum": 46074.83, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38087.78, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 21825.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32096.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 35734.04, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 27816.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21397.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 29956.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 39585.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32096.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32096.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 29956.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34236.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 33915.2, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 36302.24 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 46074.83 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 32096.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 24607.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 24607.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 31026.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 33166.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21397.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20054.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 22039.56, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30649.0, "minimum": 7324.0, "maximum": 66763.13, "payers_information": [ { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 31261.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 45973.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 51183.83, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 39843.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 42908.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 56700.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 45973.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 45973.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 42908.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49038.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 48578.67, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 52602.5 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 66763.13 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 45973.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 35246.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 35246.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 44441.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 47505.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33929.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 31568.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 7324.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 13185.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 7324.0 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 54555.22, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30649.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Breast Open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 4258.0, "minimum": 212.2, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 821.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4344.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7736.26, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8211.97, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 9241.77, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7878.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.2 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7913.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 9056.51, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 9667.66, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7027.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 7453.04, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 4386.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6561.0, "minimum": 4011.42, "maximum": 21132.8079, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11679.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6692.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9842.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10957.79, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8530.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9186.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12138.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9842.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9186.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10498.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10400.06, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10162.15 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12897.81 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9842.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7545.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7545.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9514.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10170.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4011.42 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6561.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6758.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Calcium Chloride Inj 10%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409492834", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Biopsy Of Vulva/Perineum", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1001.0, "minimum": 59.05, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 94.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1021.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1819.84, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1931.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2173.99, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1853.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1861.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2130.41, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2274.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1653.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1753.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1031.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1252.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22043.0, "minimum": 10725.0, "maximum": 47518.24, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 39236.7, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 22483.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 33064.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 36811.96, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 28656.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 22043.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 30860.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 40779.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33064.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 33064.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 30860.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35268.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 34938.31, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 37439.5 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 47518.24 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 33064.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 25349.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 25349.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 31962.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 34166.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22043.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24467.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 22043.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 22704.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10725.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 19308.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 10725.0 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37688.0, "minimum": 37688.39, "maximum": 82504.88, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 67085.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 38442.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 56532.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 62939.61, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 48994.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 37688.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 52763.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 69723.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 56532.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 56532.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 52763.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 60301.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 59736.11, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 65005.39 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 82504.88 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 56532.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 43341.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 43341.66, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 54648.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 58417.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37688.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55163.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 37688.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 38819.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy open deep", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3653.75, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 3653.75, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 602.63 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3653.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "BIOPSY OF VAGINA", "code_information": [ { "code": "57100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.0, "discounted_cash": 1001.0, "minimum": 22.24, "maximum": 3750.0, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 22.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1021.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1819.84, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.54 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1931.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2173.99, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.54 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1853.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.81 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1861.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2130.41, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2274.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1653.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1753.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.54 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1031.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1252.3, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10141.0, "minimum": 9183.118, "maximum": 20904.45, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18052.69, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10344.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15212.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 16937.07, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13184.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10141.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14198.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18762.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15212.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15213.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14198.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16227.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16075.07, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16470.57 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 20904.45 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15212.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11663.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11663.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14705.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15720.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10141.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14430.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10446.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25894.0, "minimum": 9971.0, "maximum": 60368.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 46091.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 26412.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 38841.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 43243.48, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 33662.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 51905.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 36252.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 47904.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 38841.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 38841.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 36252.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 41430.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 41042.47, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 44225.06 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 56130.47 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 38841.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 29778.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 29778.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45704.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 51905.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 60368.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 37546.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 40136.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32063.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 26671.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 20457.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 36862.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 20457.0 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8552.0, "minimum": 7531.7, "maximum": 26093.581, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15223.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8723.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12828.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 14282.27, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11117.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11973.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15821.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12828.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12828.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11973.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13683.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13555.33, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13669.64 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17349.52 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12828.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9835.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9835.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12400.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13256.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7531.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8552.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8808.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38500 - OR36038500", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 4258.0, "minimum": 245.04, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 821.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4344.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7736.26, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8211.97, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 9241.77, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7878.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.04 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7913.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 9056.51, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 9667.66, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7027.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 7453.04, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 4386.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15896.0, "minimum": 9971.0, "maximum": 60368.0, "payers_information": [ { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29407.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23844.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23844.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 22254.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25433.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25195.16, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 26608.79 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 33771.89 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23844.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18280.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18280.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45704.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 51905.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 60368.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 23049.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 24638.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28562.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16372.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19104.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 34430.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 19104.0 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 28294.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16213.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23844.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 26546.34, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 20664.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15896.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 51905.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15896.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 22254.4, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 4258.0, "minimum": 408.43, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 821.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4344.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7736.26, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8211.97, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7878.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 408.43 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7913.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7027.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 7453.04, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 4386.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26778.0, "minimum": 9971.0, "maximum": 60833.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 47665.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 27314.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 40167.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 44720.3, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 34812.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26778.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 51905.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 37490.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 49540.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 40167.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 40167.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 37490.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 42845.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 42444.08, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 45783.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 58108.02 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 40167.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 30795.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 30795.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45704.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 51905.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 60368.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 38829.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 41506.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26778.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60833.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 27581.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19104.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 34430.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 19104.0 } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.25%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409116018", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7425.0, "minimum": 5726.77, "maximum": 18836.9718, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13216.68, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7573.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11137.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12399.92, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9652.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10395.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13736.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11137.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11137.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10395.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11880.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11768.78, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11683.66 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14828.91 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11137.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8538.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8538.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10766.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11508.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5726.77 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7647.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13814.0, "minimum": 9971.0, "maximum": 60368.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24589.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14090.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20721.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 23069.76, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17958.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13814.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 51905.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19339.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25556.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20721.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20721.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19339.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22102.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21895.51, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22940.84 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 29116.53 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20721.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15886.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15886.33, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45704.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 51905.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 60368.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20030.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21412.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17347.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14228.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19104.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 34430.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 19104.0 } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.25%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150016710", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18187.0, "minimum": 18187.09, "maximum": 38895.29, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32373.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 18550.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27280.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 30372.44, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 23643.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18187.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 25461.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 33646.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27280.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27280.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 25461.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29099.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28826.55, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 30645.5 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 38895.29 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 27280.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 20915.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 20915.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 26371.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 28189.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18187.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27895.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 18732.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53320.0, "minimum": 9971.0, "maximum": 123806.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 94909.8, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 54386.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 79980.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 89044.58, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 69316.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 53320.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 74648.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 98642.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 79980.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 79980.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 74648.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 85312.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 84512.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 92547.35 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 117461.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 79980.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 61318.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 61318.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 77314.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 82646.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54076.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 54919.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 68702.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 123806.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 68702.0 } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.75%", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00409116502", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16204.0, "minimum": 16204.36, "maximum": 34461.44, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 28843.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16528.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24306.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 27061.28, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21065.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16204.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 22686.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29978.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24306.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24306.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 22686.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25926.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25683.97, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 27152.08 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 34461.44 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24306.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18635.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18635.06, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 23496.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25116.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31144.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16204.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16690.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29277.0, "minimum": 29277.39, "maximum": 63695.88, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 30155.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 52113.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 29862.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 43916.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 48893.24, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 38060.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 29277.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 40988.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 54163.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43916.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 43916.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 40988.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 46843.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 46404.68, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 50185.82 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 63695.88 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 43916.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 33669.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 33669.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 42452.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 45379.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29277.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60051.8 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 78942.0, "minimum": 9971.0, "maximum": 174759.94, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 140518.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 80521.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 118414.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 131834.71, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 102625.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 78942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 110520.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 146044.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 118414.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 118414.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 110520.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 126308.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 125124.5, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 137692.91 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 174759.94 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 118414.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 90784.38, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 90784.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 114467.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 122361.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 78942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 118174.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 78942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 81311.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 68702.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 123806.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 68702.0 } ] } ] }, { "description": "Bupivacaine Inj 0.25% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409174670", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28390.0, "minimum": 28390.68, "maximum": 61712.97, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 50535.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 28958.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 42586.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 47412.44, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 36907.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 28390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 39746.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 52522.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42586.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 42586.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 39746.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 45425.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 44999.26, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 48623.5 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 61712.97 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 42586.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 32649.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 32649.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 41166.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 44005.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45993.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 28390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 29242.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16313.0, "minimum": 16313.8, "maximum": 34706.18, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29038.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16640.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24470.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 27244.05, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21207.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 22839.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30180.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24470.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24470.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 22839.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26102.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25857.37, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 27344.91 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 34706.18 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24470.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18760.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18760.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 23655.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25286.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23173.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16313.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16803.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5858.0, "minimum": 5858.57, "maximum": 15212.9425, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10428.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5975.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8787.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7616.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8202.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10838.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8787.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8787.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8202.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9373.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9285.83, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 8923.55 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11325.78 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8787.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6737.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6737.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8494.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9080.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8050.64 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6034.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.5%", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00409156019", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15643.0, "minimum": 15643.58, "maximum": 33207.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27845.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 15956.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23465.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 26124.78, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 20336.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15643.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 21901.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28940.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23465.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23465.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 21901.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25029.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24795.11, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 26164.02 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 33207.39 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23465.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 17990.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 17990.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 22683.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 24247.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17244.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15643.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16112.89, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4429.0, "minimum": 4429.45, "maximum": 10256.4447, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 7884.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 4518.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6644.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 7397.18, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 5758.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 6201.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 8194.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6644.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 6644.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 6201.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7087.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 7020.68, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 6405.53 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 8129.91 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 6644.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 5093.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 5093.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 6422.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 6865.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5048.25 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4429.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 4562.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38525 - OR36038525", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 4258.0, "minimum": 420.32, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 821.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4344.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7736.26, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8211.97, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7878.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.32 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7913.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7027.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 7453.04, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 4386.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6670.0, "minimum": 5466.27, "maximum": 13142.54, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11874.36, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6804.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10006.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11140.55, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8672.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9339.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12341.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10006.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10006.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9339.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10673.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10573.52, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10354.98 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 13142.54 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10006.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7671.64, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7671.64, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9672.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10340.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5466.27 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6670.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6871.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5806.36, "discounted_cash": 3159.0, "minimum": 212.9, "maximum": 5806.36, "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.9 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5806.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10411.0, "minimum": 8927.4661, "maximum": 21508.26, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18533.31, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10620.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15617.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 17387.99, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13535.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10411.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14576.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19262.14, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15617.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15618.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14576.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16659.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16503.02, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16946.3 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 21508.26 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15617.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11973.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11973.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 15097.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 16138.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10411.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9875.13 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10412.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10724.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17894.0, "minimum": 17894.7, "maximum": 38241.46, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31852.58, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 18252.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26842.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 29884.17, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 23263.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17894.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 25052.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 33105.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26842.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26842.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 25052.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28631.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28363.1, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 30130.35 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 38241.46 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26842.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 20578.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 20578.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25947.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 27736.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17894.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32925.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17894.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 18431.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5316.0, "minimum": 4643.61, "maximum": 10260.72, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 9462.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5422.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7974.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 8877.99, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 6911.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 7442.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 9834.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7974.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 7442.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8505.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 8426.11, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 7967.86 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 10112.81 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7974.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6113.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6113.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 7708.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 8240.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4643.61 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5316.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 5475.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Carboprost Tromethamine Im Soln 250 Mcg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "69784024001", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12147.0, "minimum": 11076.9771, "maximum": 25390.1, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21623.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12390.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18221.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 20286.91, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15792.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12147.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 17007.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22473.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18221.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18221.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 17006.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19436.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19254.42, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 20004.8 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 25390.1 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18221.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13970.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13970.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17614.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18829.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12147.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13068.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12147.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12512.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53320.0, "minimum": 9971.0, "maximum": 117461.16, "payers_information": [ { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 98642.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 79980.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 79980.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 74648.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 85312.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 84512.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 92547.35 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 117461.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 79980.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 61318.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 61318.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 77314.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 82646.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67993.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 54919.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 94909.8, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 54386.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 79980.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 89044.58, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 69316.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 53320.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 53320.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 74648.14, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57754.0, "minimum": 57754.48, "maximum": 127377.47, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 102802.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 58909.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 86631.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 96449.98, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 75080.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 57754.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 80856.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 106845.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 86631.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 86631.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 80856.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 92407.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 91540.88, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 100360.38 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 127377.47 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 86631.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 66417.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 66417.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 83744.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 89519.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 57754.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67049.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 57754.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 59487.11, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13970.0, "minimum": 550.0, "maximum": 29466.67, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24868.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14250.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20956.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18162.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19559.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25845.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20956.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20956.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19559.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22143.72, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 23216.71 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 29466.67 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20956.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16066.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16066.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "per diem", "standard_charge_dollar": 4592.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20257.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21654.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13970.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14389.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9480.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 17084.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 9480.0 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43394.0, "minimum": 9971.0, "maximum": 114705.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 77242.23, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 44262.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 65091.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 72468.83, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 56412.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 43394.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 60752.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 80279.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 65091.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 65091.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 60752.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 69431.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 68780.28, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 75059.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 95265.14 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 65091.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 49903.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 49903.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 62922.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 67261.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43394.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53967.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 43394.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 44696.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 56321.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 101250.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 56321.0 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41057.0, "minimum": 9971.0, "maximum": 114705.0, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 59532.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 63638.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44926.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 42288.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 73081.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 41878.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 61585.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 68565.36, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 53374.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 57479.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 75955.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 61585.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 61585.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 57479.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 65691.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 65075.5, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 70940.82 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 90038.13 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 61585.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 47215.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 47215.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 41057.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8453.0, "minimum": 550.0, "maximum": 17128.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15046.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8622.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12679.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10989.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11834.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15638.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12679.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12679.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11834.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13398.34, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13495.11 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17128.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12679.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9721.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9721.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "per diem", "standard_charge_dollar": 4592.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12257.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13102.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10229.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8453.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8706.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9480.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 17084.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 9480.0 } ] } ] }, { "description": "Care Of Miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7070.05, "discounted_cash": 3521.0, "minimum": 352.07, "maximum": 7070.05, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 699.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3591.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6396.02, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6789.33, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7070.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6513.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 352.07 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6542.15, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7070.05, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7070.05, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5809.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6161.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3626.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4401.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 } ] } ] }, { "description": "Cefazolin Sodium For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614200", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.44, "10th_percentile": 2.4, "90th_percentile": 15.66, "count": "28" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 5.95, "10th_percentile": 5.95, "90th_percentile": 5.95, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.44, "10th_percentile": 10.44, "90th_percentile": 10.44, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21503.0, "minimum": 16056.0, "maximum": 46312.42, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38276.89, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 21933.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32255.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 35911.46, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 27955.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21503.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 30105.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 39782.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32255.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32255.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 30105.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34406.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 34083.68, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 36489.44 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 46312.42 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 32255.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 24729.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 24729.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 31180.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 33331.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21503.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16056.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 22148.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cefotetan Disodium For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323038510", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6545.0, "minimum": 6545.58, "maximum": 12862.08, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11651.13, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6676.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9818.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10931.12, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8509.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9163.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12109.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9818.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9818.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9163.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10472.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10374.74, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10134.0 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12862.08 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9818.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7527.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7527.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9491.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10145.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6748.15 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6545.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6741.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31714.0, "minimum": 31714.66, "maximum": 69146.18, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 56452.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 32348.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 47571.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 52963.48, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 41229.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 31714.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 44400.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 58672.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47571.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 47572.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 44400.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 50743.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 50267.8, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 54480.1 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 69146.18 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 47571.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 36471.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 36471.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 45986.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 49157.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31714.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44443.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 31714.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 2124.0, "minimum": 412.23, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4248.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 523.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2166.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3858.26, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4095.52, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4609.1, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2973.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2973.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3929.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 412.23 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2973.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3946.41, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4516.71, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4821.5, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4248.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2442.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2442.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3504.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3717.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2187.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2655.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29253.0, "minimum": 29253.4, "maximum": 63642.29, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 52071.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 29838.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 43880.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 48853.23, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 38029.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 29253.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 40954.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 54118.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43880.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 43880.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 40954.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 46805.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 46366.64, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 50143.6 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 63642.29 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 43880.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 33641.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 33641.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 42417.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 45342.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40044.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 29253.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 30131.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567070125", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.92, "10th_percentile": 0.92, "90th_percentile": 7.2, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.2, "10th_percentile": 7.2, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13271.0, "minimum": 13271.0, "maximum": 27901.78, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23622.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13536.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19906.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22162.6, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17252.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13271.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18579.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24551.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19906.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19906.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18579.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21233.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21034.54, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 21983.74 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 27901.78 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19906.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15261.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15261.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19242.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 20570.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13271.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23737.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13271.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13669.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Iv Soln 1 Gm And Dextrose 3.74% 50 Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00264315311", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.92, "10th_percentile": 0.92, "90th_percentile": 7.2, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.2, "10th_percentile": 7.2, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13382.0, "minimum": 9357.3683, "maximum": 28150.09, "payers_information": [ { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22348.04, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17396.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13382.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18734.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24756.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20073.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20073.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18734.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21411.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21210.63, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22179.39 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 28150.09 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20073.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15389.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15389.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19403.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 20742.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17113.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13783.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23820.07, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13649.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20073.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Circum 28 Days Or Older", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9976.15, "discounted_cash": 2273.0, "minimum": 188.26, "maximum": 9976.15, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.26 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20406.0, "minimum": 550.0, "maximum": 43857.91, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 36323.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 20814.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30609.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 26528.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20406.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 28568.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 37751.6, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30609.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30609.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 28568.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 32343.99, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 34555.53 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 43857.91 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30609.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 23467.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 23467.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "per diem", "standard_charge_dollar": 4592.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 29589.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 31629.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20406.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14987.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 21018.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9480.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 17084.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 9480.0 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8088.0, "minimum": 7200.2259, "maximum": 16313.4, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14398.31, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8250.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12133.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13508.53, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10515.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11324.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14964.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12133.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12133.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11324.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12942.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12820.97, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12853.29 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 16313.4 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12133.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9302.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9302.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11728.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12537.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9125.56 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8088.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8331.61, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Circumcision W/Regionl Block", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 2273.0, "minimum": 94.49, "maximum": 8430.55, "payers_information": [ { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.49 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8445.0, "minimum": 550.0, "maximum": 17110.14, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15032.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8614.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12667.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10978.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11823.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15623.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12667.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12667.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11823.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13385.67, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13481.04 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17110.14 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12667.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9712.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9712.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "per diem", "standard_charge_dollar": 4592.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12245.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13090.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7845.74 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8445.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8698.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9480.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 17084.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 9480.0 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48777.0, "minimum": 38791.1, "maximum": 107301.9, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 86823.24, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 49752.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 73165.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 81457.76, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 63410.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 68287.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 90237.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 73165.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 73165.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 68287.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 78043.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 77311.7, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 84542.9 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 107301.9 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 73165.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 56093.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 56093.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 70726.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 75604.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38791.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 48777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 50240.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6485.0, "minimum": 6485.66, "maximum": 12728.1, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11544.47, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6615.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9728.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10831.05, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8431.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9079.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11998.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9728.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9728.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9079.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10377.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10279.77, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10028.44 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12728.1 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9728.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7458.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7458.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9404.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10052.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6844.94 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6485.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6680.23, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614900", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.92, "10th_percentile": 0.92, "90th_percentile": 7.2, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.2, "10th_percentile": 7.2, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "Chemodenervation anal musc", "code_information": [ { "code": "46505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1826.87, "discounted_cash": 1301.0, "minimum": 80.3, "maximum": 1826.87, "payers_information": [ { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1826.87 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1496.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1496.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1826.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1340.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1826.87 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1826.87 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1627.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1826.87 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 80.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1826.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1327.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1826.87 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1822.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.42 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234.01 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1822.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1826.87, "additional_payer_notes": "212.65% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16947.0, "minimum": 9971.0, "maximum": 60368.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 30166.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17286.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 25420.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 28301.96, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 22031.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16947.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 51905.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 31352.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25420.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25420.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 23726.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27115.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26861.47, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 28461.06 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 36122.79 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 25420.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 19489.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 19489.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45704.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 51905.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 60368.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 24573.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 26268.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16947.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20088.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16947.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17455.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 20457.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 36862.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 20457.0 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 250 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615101", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.92, "10th_percentile": 0.92, "90th_percentile": 7.2, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.2, "10th_percentile": 7.2, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 62131.0, "minimum": 9971.0, "maximum": 137165.15, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 110593.77, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 63373.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 93197.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 103759.32, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 80770.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 62131.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 86983.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 114942.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 93197.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 93196.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 86983.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 99410.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 98478.11, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 108072.07 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 137165.15 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 93197.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 71451.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 71451.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 90090.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 96303.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62131.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78322.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 62131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 63995.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 56184.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 101250.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 56184.0 } ] } ] }, { "description": "Ceftriaxone Sodium For Iv Soln 2 Gm And Dextrose 2.22% 50 Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00264315511", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.92, "10th_percentile": 0.92, "90th_percentile": 7.2, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.2, "10th_percentile": 7.2, "90th_percentile": 7.2, "count": "1 through 10" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7751.0, "minimum": 5881.22, "maximum": 20978.8971, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13796.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7906.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11626.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12944.22, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10076.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10851.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14339.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11626.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11626.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10851.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12401.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12285.38, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12257.92 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15557.76 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11626.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8913.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8913.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11238.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12014.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5881.22 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7751.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7983.56, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19890.0, "minimum": 19890.2, "maximum": 42703.89, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 35404.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 20288.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29835.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 33216.65, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 25857.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19890.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 27846.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 36796.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29835.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29835.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 27846.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31824.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 31525.97, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 33646.29 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 42703.89 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 29835.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 22873.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 22873.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 28840.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 30829.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19890.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28305.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19890.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 20486.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17303.0, "minimum": 17303.57, "maximum": 36919.53, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 30800.35, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17649.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 25955.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 28896.96, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 22494.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17303.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 24225.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32011.6, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25955.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25955.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 24225.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27685.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27426.21, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 29088.8 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 36919.53 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 25955.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 19899.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 19899.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25090.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 26820.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17303.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23117.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17303.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17822.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 10 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567070810", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.44, "10th_percentile": 2.4, "90th_percentile": 15.66, "count": "28" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 5.95, "10th_percentile": 5.95, "90th_percentile": 5.95, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.44, "10th_percentile": 10.44, "90th_percentile": 10.44, "count": "1 through 10" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12978.0, "minimum": 12881.6, "maximum": 30307.6017, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23101.98, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13238.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19467.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 21674.33, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 16872.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12978.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18170.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24010.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19467.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18170.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20765.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20571.08, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 21468.6 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 27247.96 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19467.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 14925.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 14925.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 18819.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 20116.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12881.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12978.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13368.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24328.0, "minimum": 7324.0, "maximum": 52629.13, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 43304.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 24815.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 36492.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 40628.71, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 31627.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 24328.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 34060.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 45007.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 36492.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 36492.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 34060.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 38925.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 38560.83, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 41466.36 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 52629.13 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 36492.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 27977.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 27977.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 35276.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 37709.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24328.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28390.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 24328.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 25058.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 7324.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 13185.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 7324.0 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11684.0, "minimum": 11684.5, "maximum": 24353.99, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20798.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11918.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17526.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 19513.15, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15189.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11684.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16358.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21616.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17526.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16358.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18695.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18519.93, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 19188.45 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 24353.99 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17526.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13437.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13437.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16942.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18111.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11684.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23393.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12035.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505623100", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.44, "10th_percentile": 2.4, "90th_percentile": 15.66, "count": "28" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 5.95, "10th_percentile": 5.95, "90th_percentile": 5.95, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.44, "10th_percentile": 10.44, "90th_percentile": 10.44, "count": "1 through 10" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45722.0, "maximum": 66293.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 45722.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 66293.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 45722.0 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20296.0, "minimum": 7324.0, "maximum": 43611.38, "payers_information": [ { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 33894.37, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 26384.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20296.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 28414.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 37547.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30444.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30444.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 28414.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32473.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 32169.16, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 34361.3 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 43611.38 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30444.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 23340.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 23340.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 29429.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 31458.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24258.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 20904.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 7324.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 13185.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 7324.0 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 36126.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 20701.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30444.05, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9642.0, "minimum": 9297.51, "maximum": 19787.95, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17163.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9835.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14464.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 16103.28, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12535.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13499.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17838.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14464.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14464.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13499.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15428.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15283.65, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 15590.88 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 19787.95 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14464.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11089.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11089.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13981.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 14946.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9297.51 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9642.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9931.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cefotetan Disodium For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323038620", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16468.0, "minimum": 15413.5, "maximum": 35052.74, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29314.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16798.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24703.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 27502.86, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21409.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16468.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 23056.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30467.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24703.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24703.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 23056.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26350.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26103.05, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 27617.97 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 35052.74 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24703.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18939.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18939.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 23879.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25526.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16468.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15413.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16962.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9262.0, "minimum": 550.0, "maximum": 18937.63, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16487.13, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9447.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13893.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12041.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12967.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17135.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13893.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13893.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12967.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14680.95, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 14920.91 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 18937.63 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13893.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10651.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10651.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "per diem", "standard_charge_dollar": 4592.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13430.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 14356.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9456.07 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9262.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9540.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9480.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 17084.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 9480.0 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6293.0, "minimum": 6189.07, "maximum": 24930.6994, "payers_information": [ { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7237.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9125.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9754.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6189.07 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6481.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11201.79, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6419.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9439.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10509.54, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8181.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11642.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9439.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8810.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10069.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9974.63, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9689.23 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12297.58 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9439.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7237.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9715.0, "minimum": 550.0, "maximum": 19950.52, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17293.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9909.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14573.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12629.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13601.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17973.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14573.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14573.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13601.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15398.88, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 15718.96 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 19950.52 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14573.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11172.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11172.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "per diem", "standard_charge_dollar": 4592.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 5216.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14087.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15058.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13996.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9715.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10006.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9480.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 17084.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 9480.0 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9342.0, "minimum": 7580.0, "maximum": 38566.0562, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16629.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9529.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14013.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 15601.67, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12145.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13079.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17283.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14013.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14013.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13079.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14947.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14807.58, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 15061.66 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 19116.27 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 7580.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14013.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10743.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10743.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13546.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 14480.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12480.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9342.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9622.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 16139.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 14107.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 16139.0 } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9569.0, "minimum": 9569.99, "maximum": 19625.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17034.58, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9761.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14354.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 15981.88, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12440.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13397.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17704.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14354.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14354.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13397.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15311.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15168.43, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 15462.8 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 19625.39 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14354.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11005.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11005.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13876.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 14833.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15662.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9569.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9857.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39172.0, "minimum": 26549.6406, "maximum": 85824.02, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 69727.3, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 39956.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 58758.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 65418.31, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 50924.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 39172.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 54841.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 72469.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 58758.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 58758.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 54841.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 62676.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 62088.57, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 67620.52 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 85824.02 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 58758.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 45048.54, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 45048.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 56800.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 60717.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39172.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52386.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 39172.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 40347.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323041605", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39367.0, "minimum": 13864.0, "maximum": 86259.9, "payers_information": [ { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 72829.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 59051.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 59051.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 55114.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 62988.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 62397.65, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 67963.95 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 86259.9 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 59051.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 45272.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 45272.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 57082.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 61019.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45357.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 40548.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13864.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 22755.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 13864.0 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 70074.26, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 40154.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 59051.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 65743.83, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 51177.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 39367.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 39367.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 55114.64, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10007.0, "minimum": 10007.75, "maximum": 20604.34, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17813.8, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10207.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15011.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 16712.94, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13010.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10007.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14010.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18514.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15011.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15011.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14010.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16012.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15862.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16234.11 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 20604.34 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15011.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11508.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11508.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14511.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15512.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10007.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12940.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10307.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17468.0, "minimum": 16009.6, "maximum": 37289.31, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31094.7, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17818.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26203.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 29173.11, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 22709.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17468.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 24456.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32317.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26203.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26203.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 24456.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27950.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27688.21, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 29380.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 37289.31 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26203.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 20089.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 20089.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25329.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 27076.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17468.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16009.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17993.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7473.0, "minimum": 7473.83, "maximum": 27517.2559, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13303.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7623.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11210.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12481.3, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9715.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13826.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11210.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11210.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10463.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11958.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11846.02, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11769.52 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14937.88 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11210.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8594.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8594.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10837.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11584.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8320.39 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7473.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7698.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12328.0, "minimum": 10589.7, "maximum": 46100.5599, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21944.53, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12574.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18492.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 20588.41, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 16026.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12328.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22807.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18492.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18492.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 17259.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19725.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19540.51, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 20322.89 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 25793.83 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18492.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 14177.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 14177.66, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17876.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 19109.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10589.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12328.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12698.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7579.0, "minimum": 7503.91, "maximum": 38613.0845, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13491.12, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7730.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11368.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12657.4, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9853.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10610.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14021.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11368.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10610.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12126.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12013.16, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11955.31 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15173.68 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11368.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8716.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8716.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10989.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11747.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7503.91 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7579.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7806.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14614.3, "discounted_cash": 7892.0, "minimum": 652.99, "maximum": 14614.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14614.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14337.11, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14614.3, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 14614.3, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14601.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 652.99 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14614.3, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 14614.3, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 14614.3, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14614.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13022.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13812.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8129.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9865.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11244.0, "minimum": 9304.72, "maximum": 23369.68, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20014.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11469.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16866.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 18778.08, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14617.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11244.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 15742.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20802.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16866.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16866.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 15742.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17990.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17822.37, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 18412.92 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 23369.68 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16866.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12931.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12931.06, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16304.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 17428.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9304.72 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11581.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [ { "code": "57282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9133.75, "discounted_cash": 8065.0, "minimum": 167.63, "maximum": 9133.75, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 167.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8227.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 478.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 478.94 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.52 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 478.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 478.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9133.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 61866.0, "minimum": 9971.0, "maximum": 136573.85, "payers_information": [ { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 86613.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 114453.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 92800.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 92800.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 86613.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 98987.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 98059.04, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 107606.19 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 136573.85 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 92800.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 71146.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 71146.94, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 89707.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 95893.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80799.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 63722.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 53775.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 96904.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 53775.0 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 110123.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 63104.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 92800.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 103317.74, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 80426.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 61866.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 61866.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 345755.0, "minimum": 345755.83, "maximum": 771417.54, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 615445.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 352670.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 518633.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 577412.24, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 449482.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 345755.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 484058.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 639648.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 518633.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 518634.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 484058.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 553209.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 548023.26, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 607797.91 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 771417.54 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 518633.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 397619.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 397619.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 501345.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 535921.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 345755.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 373984.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 345756.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 356128.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9449.0, "minimum": 9449.36, "maximum": 19355.64, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16819.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9638.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14174.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 15780.43, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12284.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13229.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17481.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14174.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14174.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13229.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15118.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14977.24, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 15250.26 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 19355.64 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14174.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10866.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10866.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13701.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 14646.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10337.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9449.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9732.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27182.0, "minimum": 27182.0, "maximum": 59010.15, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 48384.01, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 27725.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 40773.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 45393.99, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 35336.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 27182.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 38054.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 50286.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 40773.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 40773.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 38054.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43491.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 43083.47, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 46493.95 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 59010.15 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 40773.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 31259.33, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 31259.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 39413.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 42132.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27182.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31273.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 27182.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 27997.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49224.0, "minimum": 9971.0, "maximum": 118145.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 50701.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 65564.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 118145.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 65564.0 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 87619.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 50208.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 73836.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 82204.83, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 63991.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 49224.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 68914.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 91065.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 73836.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 73836.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 68914.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 78759.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 78020.67, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 85331.1 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 108302.29 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 73836.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 56608.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 56608.06, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 71375.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 76297.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49224.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69815.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 49224.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 87660.0, "minimum": 87660.69, "maximum": 194254.92, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 156036.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 89413.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 131491.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 146393.35, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 113958.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 87660.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 122724.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 162172.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 131491.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 131491.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 122724.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 140257.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 138942.21, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 153052.96 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 194254.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 131491.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 100809.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 100809.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 127108.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 135874.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 87660.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 124504.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 87660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 90290.51, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Claviculectomy Partial", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13027.4, "discounted_cash": 3559.0, "minimum": 567.27, "maximum": 13027.4, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 567.27 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 } ] } ] }, { "description": "Control Throat Bleeding", "code_information": [ { "code": "42960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 586.0, "minimum": 48.57, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 48.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 598.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1065.61, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 57.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1131.14, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 879.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1272.99, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 821.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 57.14 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1085.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 879.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 879.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.68 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 821.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1089.96, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1247.47, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1331.65, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 674.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 674.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 967.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1026.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 57.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 57.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 604.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 733.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9028.0, "minimum": 9028.37, "maximum": 18414.21, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16070.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9208.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13542.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 15077.38, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11736.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12639.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16702.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13542.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13542.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12639.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14445.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14309.97, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 14508.51 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 18414.21 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13542.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10382.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10382.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13091.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13993.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9647.58 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9028.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9299.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17589.0, "minimum": 17589.5, "maximum": 37559.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17941.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26384.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 29374.55, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 22866.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17589.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 24625.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32540.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26384.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26384.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 24625.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28143.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27879.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 29592.69 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 37559.06 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26384.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 20227.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 20227.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25504.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 27263.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24361.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17589.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 18117.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31309.4, "additional_payer_notes": "178.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13153.1, "discounted_cash": 3559.0, "minimum": 583.82, "maximum": 13153.1, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.82 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14058.0, "minimum": 14058.67, "maximum": 29663.17, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25024.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14339.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21088.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 23477.98, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18276.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14058.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19682.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26008.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21088.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21088.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19682.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22493.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22283.04, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 23371.54 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 29663.17 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21088.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16167.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16167.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20385.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21790.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14058.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19000.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14058.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14480.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 68135.0, "minimum": 9971.0, "maximum": 150591.73, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 121281.05, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 69498.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 102203.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 113786.15, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 88576.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 68135.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 95389.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 126050.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 102203.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 102203.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 95389.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 109016.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 107994.61, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 118650.84 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 150591.73 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 102203.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 78355.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 78355.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 98796.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 105609.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68135.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60998.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 68135.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 70179.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 65564.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 118145.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 65564.0 } ] } ] }, { "description": "CLOSURE OF VAGINA", "code_information": [ { "code": "57120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11157.85, "discounted_cash": 5441.0, "minimum": 171.43, "maximum": 11157.85, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 171.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5550.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10491.82, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 11157.85, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10066.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 499.61 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10109.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 11157.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 11157.85, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8978.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 9522.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5604.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 6801.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "CHROMOTUBATION OF OVIDUCT,INC MATERIALS", "code_information": [ { "code": "58350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5332.79, "discounted_cash": 5441.0, "minimum": 76.82, "maximum": 5332.79, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1215.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.82 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5332.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Corrj Halux Rigdus W/O Implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3559.0, "minimum": 532.63, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.63 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "COLPOPEXY INTRAPERITONEAL", "code_information": [ { "code": "57283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24664.49, "discounted_cash": 8065.0, "minimum": 2588.18, "maximum": 24664.49, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 10082.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16131.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2588.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8227.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14651.69, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15552.65, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12098.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 17502.98, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11292.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11292.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14921.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12098.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12098.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11292.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14986.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 17152.12, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 18309.57, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16131.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9275.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9275.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13308.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 14115.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8065.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7528.0, "minimum": 7528.15, "maximum": 15059.35, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13400.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7678.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11292.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12572.01, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9786.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10539.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13927.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11292.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11292.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10539.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12045.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11932.12, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11865.23 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15059.35 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11292.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8657.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8657.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10915.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11668.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8272.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7528.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7753.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37611.0, "maximum": 66293.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 37611.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 66293.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 37611.0 } ] } ] }, { "description": "Cysto W/Urtrl Cathj", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 2273.0, "minimum": 127.67, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.67 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5922.0, "minimum": 5155.33, "maximum": 11468.69, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10542.01, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6040.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8883.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9890.54, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7699.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8291.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10956.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8883.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8883.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8291.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9475.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9387.13, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9036.15 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11468.69 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8883.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6810.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6810.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8587.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9179.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5155.33 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5922.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6100.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CPTRASST DIR MS PX", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13027.63, "minimum": 49.11, "maximum": 13027.63, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 49.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.12 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23986.0, "maximum": 43179.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 23986.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 43179.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 23986.0 } ] } ] }, { "description": "Cystoscopy And Treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10337.9, "discounted_cash": 3834.0, "minimum": 275.71, "maximum": 10337.9, "payers_information": [ { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 6326.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6709.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6964.79, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7393.07, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8320.17, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7093.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.71 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7123.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8153.38, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8703.59, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18470.0, "minimum": 7580.0, "maximum": 39529.46, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32877.79, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 18840.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27706.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 30846.02, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 24011.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18470.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 25858.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34170.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27706.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27706.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 25858.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29553.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 29276.06, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 31145.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 39529.46 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 7580.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 27706.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 21241.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 21241.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 26782.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 28629.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18470.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20987.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 19024.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10614.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 18039.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 10614.0 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25631.0, "minimum": 25631.48, "maximum": 55542.75, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 45624.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 26144.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 38447.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 42804.57, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 33320.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25631.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 35884.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 47418.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 38447.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 38447.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 35884.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 41010.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 40625.93, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 43761.99 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 55542.75 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 38447.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 29476.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 29476.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 37165.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 39728.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25631.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29243.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 26400.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8800.0, "minimum": 8503.67, "maximum": 17905.09, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15665.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8976.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13201.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 14697.17, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11440.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12320.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16281.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13201.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13201.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12320.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14081.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13949.11, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 14107.37 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17905.09 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13201.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10120.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10120.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12761.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13641.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8503.67 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9064.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52240 - OR36052240", "code_information": [ { "code": "52240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15344.9, "discounted_cash": 5832.0, "minimum": 374.72, "maximum": 15344.9, "payers_information": [ { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7290.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5948.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10594.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11245.47, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 12655.68, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10789.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 374.72 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10836.06, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12401.98, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13238.89, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9622.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10206.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6007.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9231.0, "minimum": 9231.28, "maximum": 18867.96, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16431.68, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9415.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13846.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 15416.24, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12000.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12923.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17077.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13846.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13846.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12923.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14770.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14631.58, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 14866.02 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 18867.96 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13846.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10615.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10615.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13385.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 14308.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10392.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9231.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9508.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20947.0, "minimum": 20947.88, "maximum": 45069.09, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 37287.23, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 21366.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 31421.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 34982.96, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 27232.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20947.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 29327.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 38753.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31421.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 31421.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 29327.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33516.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 33202.42, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 35509.82 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 45069.09 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 31421.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 24090.06, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 24090.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 30374.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 32469.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29195.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20947.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 21576.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15419.0, "minimum": 12748.2537, "maximum": 32705.41, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27446.0, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 15727.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23128.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 25749.9, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 20044.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 21586.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28525.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23128.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23128.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 21586.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24670.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24439.27, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 25768.51 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 32705.41 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23128.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 17731.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 17731.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 22357.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 23899.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14681.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15419.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 15881.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52305 - OR36052305", "code_information": [ { "code": "52305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18547.2, "discounted_cash": 5832.0, "minimum": 266.57, "maximum": 18547.2, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1171.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5948.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10594.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11245.47, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 12655.68, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10789.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 266.57 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10836.06, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12401.98, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13238.89, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9622.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10206.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6007.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7290.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16516.0, "minimum": 16516.7, "maximum": 35159.92, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29399.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16847.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24775.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 27582.91, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21471.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16516.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 23123.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30555.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24775.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24775.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 23123.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26426.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26178.97, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 27702.42 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 35159.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24775.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18994.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18994.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 23949.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25600.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20396.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16516.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17012.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54564.0, "minimum": 47861.597, "maximum": 120244.37, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 97125.18, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 55656.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 81847.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 91123.07, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 70934.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 54564.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 76390.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 100944.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 81847.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 81847.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 76390.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 87303.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 86485.05, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 94740.23 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 120244.37 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 81847.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 62749.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 62749.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 79118.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 84575.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54564.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103064.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 54564.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 56201.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7369.0, "minimum": 7369.98, "maximum": 14705.64, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13118.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7517.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11054.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12307.87, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9580.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10317.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13634.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11054.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11054.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10317.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11791.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11681.42, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11586.54 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14705.64 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11054.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8475.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8475.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10686.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11423.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12831.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7369.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7591.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9063.23, "discounted_cash": 2273.0, "minimum": 145.37, "maximum": 9063.23, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.37 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46569.0, "minimum": 46569.9, "maximum": 102366.08, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 47967.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 82894.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 47501.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 69854.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 77771.75, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 60540.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 46569.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 65197.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 86154.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 69854.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 69854.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 65197.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 74511.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 73813.29, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 80653.97 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 102366.08 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 69854.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 53555.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 53555.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 67526.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 72183.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46569.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65170.1 } ] } ] }, { "description": "Conization Of Cervix - 57520 - OR36057520", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9218.71, "discounted_cash": 3521.0, "minimum": 267.2, "maximum": 9218.71, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 699.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3591.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6396.02, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6789.33, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7640.72, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7734", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7734.0, "10th_percentile": 7734.0, "90th_percentile": 7734.0, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6513.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.2 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6542.15, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7487.56, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7992.83, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7734", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7734.0, "10th_percentile": 7734.0, "90th_percentile": 7734.0, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5809.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6161.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3626.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4401.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Cystouretero W/Biopsy", "code_information": [ { "code": "52354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 5832.0, "minimum": 398.53, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5948.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 398.53 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6007.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7290.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2831.59, "discounted_cash": 7892.0, "minimum": 490.05, "maximum": 2831.59, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 490.05 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2831.59 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2831.59 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2831.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Dantrolene Sodium For Iv Susp 250 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "42367054032", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Clsd Tx Nsl Fx W/Mnpj&Stablj", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3606.0, "minimum": 131.72, "maximum": 10961.3, "payers_information": [ { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.72 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6700.47, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7668.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8186.26, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7212.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4147.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4147.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5950.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6310.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3714.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4507.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7212.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 607.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3678.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6550.81, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6953.63, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7825.63, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10539.5, "discounted_cash": 3834.0, "minimum": 234.68, "maximum": 10539.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6964.79, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7393.07, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8320.17, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7093.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234.68 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7123.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8153.38, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8703.59, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 6326.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6709.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34255.0, "minimum": 9971.0, "maximum": 114705.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 60975.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 34940.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 51383.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 57207.14, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 44532.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34255.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 47958.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 63373.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 51383.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 51383.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 47958.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 54809.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 54295.44, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 58957.36 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 74828.72 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 51383.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 39394.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 39394.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 49670.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 53096.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34255.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50323.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34255.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 35283.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 45722.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 82399.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 45722.0 } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 803.0, "minimum": 152.06, "maximum": 8430.55, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 828.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1004.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 161.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 819.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1460.28, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 189.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1550.08, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1744.46, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1850.05, "10th_percentile": 865.44, "90th_percentile": 1850.05, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 189.46 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1487.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.06 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1493.65, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1709.49, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1824.85, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 924.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 924.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1326.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1406.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 189.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 189.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cmbn Ant Pst Colprhy", "code_information": [ { "code": "57260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18723.5, "discounted_cash": 5441.0, "minimum": 816.05, "maximum": 18723.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1215.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5550.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10491.82, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 11807.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10066.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 816.05 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10109.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 11570.82, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12351.64, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8978.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 9522.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5604.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 6801.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 } ] } ] }, { "description": "Cystoscopy And Treatment - 52276 - OR36052276", "code_information": [ { "code": "52276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 2273.0, "minimum": 253.18, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 253.18 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32043.0, "minimum": 32043.78, "maximum": 69882.18, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 57037.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 32684.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 48065.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 53513.11, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 41656.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 32043.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 44861.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 59280.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 48065.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 48065.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 44861.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 51270.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 50789.42, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 55059.99 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 69882.18 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 48065.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 36850.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 36850.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 46463.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 49667.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32043.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40136.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 32043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 33005.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt skin xtrnl gent&per", "code_information": [ { "code": "11004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7587.51, "minimum": 192.1, "maximum": 7587.51, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 192.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4473.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 548.86 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 548.86 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 559.84 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 548.86 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 548.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Cmbn Ap Colprhy W/Ntrcl Rpr", "code_information": [ { "code": "57265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16440.9, "discounted_cash": 5441.0, "minimum": 893.56, "maximum": 16440.9, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1215.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5471.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5550.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10491.82, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3303.12 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 11807.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10066.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8161.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 893.56 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 7617.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10109.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 11570.82, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12351.64, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10882.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3290.53 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6257.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8978.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 9522.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3290.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1430.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5441.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5604.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 6801.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3392.3 } ] } ] }, { "description": "Cystoscopy And Treatment - 52281 - OR36052281", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13948.3, "discounted_cash": 2273.0, "minimum": 146.51, "maximum": 13948.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.51 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Create Eardrum Opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1687.0, "minimum": 157.14, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3375.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 607.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1721.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3065.67, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3254.18, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3662.27, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2362.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2362.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3122.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.14 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2362.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3135.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3588.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3831.03, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3375.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1940.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1940.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2784.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2953.44, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1738.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2109.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9695.91, "discounted_cash": 442.0, "minimum": 59.48, "maximum": 9695.91, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 455.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 552.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 84.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 451.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 803.2, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.59, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 959.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1207.51, "10th_percentile": 58.31, "90th_percentile": 1207.51, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.48 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 821.55, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 940.27, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1003.73, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 508.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 508.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 729.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 773.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7189.0, "minimum": 6104.65, "maximum": 14301.92, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12797.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7333.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10784.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12006.36, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9346.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13300.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10784.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10784.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10065.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11503.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11395.26, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11268.45 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14301.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10784.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8267.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8267.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10424.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11143.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6104.65 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7189.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7405.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9984.82, "discounted_cash": 3834.0, "minimum": 149.14, "maximum": 9984.82, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6964.79, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7393.07, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8320.17, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7093.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.14 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7123.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8153.38, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8703.59, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 6326.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6709.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Deep muscle biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7672.48, "discounted_cash": 3159.0, "minimum": 150.09, "maximum": 7672.48, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.09 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11592.0, "minimum": 11592.65, "maximum": 25027.6062, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11940.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20634.92, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11824.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17388.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 19359.73, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15070.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11592.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16229.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21446.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17388.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17389.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16229.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18548.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18374.43, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 19026.59 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 24148.56 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17388.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13331.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13331.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16809.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 17968.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11592.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16122.9 } ] } ] }, { "description": "Dantrolene Sodium For Iv Soln 20 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "42023012306", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Delay Flap Eye/Nos/Ear/Lip", "code_information": [ { "code": "15630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18727.5, "discounted_cash": 2244.0, "minimum": 336.24, "maximum": 18727.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4076.7, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4327.38, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4870.04, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4151.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 336.24 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4169.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4772.42, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5094.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3703.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3927.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2311.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2805.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3521.0, "minimum": 238.4, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 699.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3591.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6396.02, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6789.33, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7640.72, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6513.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.4 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6542.15, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7487.56, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7992.83, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5809.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6161.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3626.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4401.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8063.846, "maximum": 14034.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14034.8 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6453.0, "minimum": 6000.65, "maximum": 27279.2642, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11487.6, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6582.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9680.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10777.7, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8389.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9035.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11939.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9680.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9035.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10325.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10229.13, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9972.14 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12656.64 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9680.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7421.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7421.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9357.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10003.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6000.65 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6453.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6647.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20618.0, "minimum": 14670.0946, "maximum": 44333.09, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 31959.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24957.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 21237.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 36701.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 21031.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30928.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 34433.33, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 26804.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20618.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 28866.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 38144.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30928.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30928.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 28866.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32990.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 32680.8, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 34929.93 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 44333.09 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30928.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 23711.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 23711.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 20618.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 29897.2, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11143.0, "minimum": 11143.7, "maximum": 23144.6, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19835.79, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11366.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16715.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 18609.98, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14486.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 15601.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20615.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16715.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16715.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 15601.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17829.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17662.76, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 18235.57 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 23144.6 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16715.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12815.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12815.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16158.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 17272.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16636.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11143.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11478.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Destruction Vag Lesions Smpl", "code_information": [ { "code": "57061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13701.3, "discounted_cash": 3521.0, "minimum": 33.02, "maximum": 13701.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 33.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3591.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6396.02, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6789.33, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7640.72, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.35 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6513.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.24 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6542.15, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7487.56, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7992.83, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5809.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6161.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.35 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3626.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4401.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3288.27, "discounted_cash": 3559.0, "minimum": 504.4, "maximum": 3288.27, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.4 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3288.27 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3288.27 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12690.7, "discounted_cash": 5832.0, "minimum": 1171.9, "maximum": 12690.7, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1171.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5948.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10594.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11245.47, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3635.8 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 12655.68, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10789.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10836.06, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12401.98, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12690.7, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9622.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10206.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3621.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6007.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7290.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3733.97 } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55150030401", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 2.11, "count": "41" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 1.21, "10th_percentile": 0.8, "90th_percentile": 1.58, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.58, "10th_percentile": 1.4, "90th_percentile": 3.51, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44432.0, "minimum": 9971.0, "maximum": 114705.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 79089.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 45320.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 66648.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 74201.79, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 57761.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44432.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 62205.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 82199.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 66648.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 66648.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 62205.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 71091.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 70425.04, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 76887.5 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 97585.67 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 66648.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 51097.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 51097.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 64426.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 68869.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44432.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66271.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 44432.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 45765.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 53775.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 96904.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 53775.0 } ] } ] }, { "description": "Cystoscopy And Treatment - 52315 - OR36052315", "code_information": [ { "code": "52315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16441.3, "discounted_cash": 2273.0, "minimum": 261.85, "maximum": 16441.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 261.85 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml - 00641614501", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641614501", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 2.11, "count": "41" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 1.21, "10th_percentile": 0.8, "90th_percentile": 1.58, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.58, "10th_percentile": 1.4, "90th_percentile": 3.51, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47674.0, "minimum": 9971.0, "maximum": 114705.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 84860.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 48628.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 71512.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 79616.75, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 61977.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 74654.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 66744.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 88198.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 71512.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 71512.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 66744.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 76279.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 75564.4, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 82600.55 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 104836.67 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "case rate", "standard_charge_dollar": 9971.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 71512.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 54825.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 54825.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 67013.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "per diem", "standard_charge_dollar": 74654.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 114705.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 69128.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 73895.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62265.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 47674.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 49104.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 45722.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 82399.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 45722.0 } ] } ] }, { "description": "Destruction anal lesion(s) - 46910 - ", "code_information": [ { "code": "46910", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4590.48, "discounted_cash": 2244.0, "minimum": 45.1, "maximum": 4590.48, "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4151.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.44 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4169.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4590.48, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4590.48, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3703.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3927.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2311.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2805.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 45.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4076.7, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4327.38, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4590.48, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.86 } ] } ] }, { "description": "CYSTOSCOPY WBIOPSY(S)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7340.12, "discounted_cash": 2273.0, "minimum": 135.65, "maximum": 7340.12, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.65 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml - 63323016503", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323016503", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 2.11, "count": "41" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 1.21, "10th_percentile": 0.8, "90th_percentile": 1.58, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.58, "10th_percentile": 1.4, "90th_percentile": 3.51, "count": "1 through 10" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35362.0, "minimum": 35362.97, "maximum": 77304.67, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 62946.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 36070.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 53044.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 59056.16, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 45971.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 35362.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 49508.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 65421.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53044.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 53044.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 49508.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 56580.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 56050.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 60908.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 77304.67 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 53044.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 40667.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 40667.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 51276.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 54812.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35362.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54456.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 35363.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 36423.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Destruction Anal Lesion(S) - 46924 - OR36046924", "code_information": [ { "code": "46924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6483.85, "discounted_cash": 3019.0, "minimum": 178.93, "maximum": 6483.85, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 624.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3079.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5484.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5821.49, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6483.85, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5585.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.93 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5609.54, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6420.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6483.85, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4981.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5283.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3109.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3773.91, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12179.0, "discounted_cash": 5832.0, "minimum": 374.35, "maximum": 12179.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1171.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5948.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10594.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11245.47, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 12179.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10789.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 374.35 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10836.06, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12179.0, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12179.0, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11664.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9622.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10206.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6007.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7290.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Dexmedetomidine Hcl Iv Soln 200 Mcg/2Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "16729023930", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25965.0, "minimum": 25965.4, "maximum": 71075.4374, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 46218.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 26484.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 38948.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 43362.22, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 33755.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 36351.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 48035.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 38948.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 38948.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 36351.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 41544.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 41155.16, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 44350.33 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 56289.46 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 38948.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 29860.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 29860.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 37649.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 40246.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41049.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 26744.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DESTRUCTION PENIS LESION(S)", "code_information": [ { "code": "54065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7500.0, "discounted_cash": 2244.0, "minimum": 166.82, "maximum": 7500.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4076.7, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4327.38, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4870.04, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4151.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.82 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4169.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4772.42, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5094.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3703.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3927.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2311.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2805.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17162.0, "minimum": 12228.0, "maximum": 36605.12, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 30550.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 17506.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 25744.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 22311.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17162.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 24028.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 31751.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25744.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25744.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 24028.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27460.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27203.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 28841.08 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 36605.12 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 25744.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 19737.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 19737.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 24886.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 26602.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17162.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15695.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17163.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 17677.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 10% Amino Acids 3% Calcium Gluconate 300 Mg/100 Ml Heparin 0.5 Units/Ml 250 Ml (Neonate) - Premix", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "99999109315", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26439.0, "minimum": 26439.9, "maximum": 57350.59, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 47063.04, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 26968.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39659.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 44154.65, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 34371.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26439.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 37015.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 48913.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 39659.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 39659.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 37015.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 42303.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 41907.24, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 45186.38 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 57350.59 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 39659.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 30405.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 30405.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 38337.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 40981.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26439.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32710.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26439.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 27233.11, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 0.5 Mg", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054817925", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.64, "10th_percentile": 0.48, "90th_percentile": 1.6, "count": "1 through 10" } ] } ] }, { "description": "Dextrose Inj 10%", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00264752020", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Dexmedetomidine Hcl In Nacl 0.9% Iv Soln 400 Mcg/100Ml", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00409159601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Decompress spine cord add-on", "code_information": [ { "code": "63057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4367.6, "minimum": 107.65, "maximum": 4367.6, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 107.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.56 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.56 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.71 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.56 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13609.0, "minimum": 13609.7, "maximum": 28659.22, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24225.32, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13881.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20414.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22728.25, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17692.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13609.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19053.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25178.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20414.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20414.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19053.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21775.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21571.37, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22580.52 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 28659.22 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20414.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15651.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15651.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19734.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21095.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13609.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15493.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14018.02, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% Amino Acids 3% Calcium Gluconate 300 Mg/100 Ml Heparin 0.5 Units/Ml 250 Ml (Neonate)- Premix", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "99999409316", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5788.4169, "maximum": 9026.71, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9026.71 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37114.0, "minimum": 37114.8, "maximum": 81222.25, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 66064.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 37857.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 55672.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 61981.75, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 48249.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 37114.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 51960.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 68662.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 55672.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 55672.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 51960.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 59383.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 58826.96, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 63994.8 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 81222.25 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 55672.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 42682.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 42682.02, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 53816.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 57527.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37114.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43989.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 37114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 38228.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.2%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264761600", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6.0, "10th_percentile": 5.9, "90th_percentile": 6.0, "count": "17" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6.0, "10th_percentile": 5.9, "90th_percentile": 6.0, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13816.0, "minimum": 13816.6, "maximum": 29121.89, "payers_information": [ { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15889.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20034.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21415.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16809.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14231.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24593.6, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14092.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20724.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 23073.77, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17961.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13816.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19343.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25560.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20724.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20724.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19343.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22106.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21899.31, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22945.07 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 29121.89 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20724.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15889.12, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19351.0, "minimum": 19351.8, "maximum": 41499.86, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 34446.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 19738.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29027.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 32317.51, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 25157.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 35800.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29027.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29027.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 27092.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30962.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30672.6, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 32697.63 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 41499.86 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 29027.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 22254.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 22254.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 28060.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 29995.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24912.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 19932.35, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9536.0, "minimum": 9045.25, "maximum": 19550.36, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16974.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9727.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14304.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 15925.85, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12397.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13351.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17642.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14304.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14304.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13351.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15258.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15115.26, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 15403.68 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 19550.36 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14304.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10966.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10966.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13827.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 14781.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9045.25 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9536.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9822.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cysto Rx Balo Cath Urtl Strx", "code_information": [ { "code": "52284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 5832.0, "minimum": 1779.27, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10961.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1779.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5948.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10594.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10961.3, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 10961.3, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10789.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8748.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8164.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10836.06, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 10961.3, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 10961.3, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10961.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6706.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9622.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10206.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5832.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6007.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7290.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Dextrose Inj 70%", "drug_information": { "unit": 2000.0, "type": "ML" }, "code_information": [ { "code": "00338071906", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "CYSTO WURETER STRICTURE TX", "code_information": [ { "code": "52341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5480.42, "discounted_cash": 3834.0, "minimum": 271.33, "maximum": 5480.42, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.33 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5480.42, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5756.0, "minimum": 4721.86, "maximum": 19033.6356, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10246.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5871.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8634.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9613.05, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7483.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8058.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10649.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8634.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8634.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8058.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9210.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9123.77, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 8743.39 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11097.12 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8634.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6619.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6619.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8346.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 8922.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4721.86 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5756.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 5929.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8061.0, "minimum": 8061.78, "maximum": 35969.524, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14349.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8223.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12092.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13463.17, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10480.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14914.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12092.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12092.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11286.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12898.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12777.92, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12805.44 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 16252.67 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12092.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9271.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9271.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11689.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12495.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8450.12 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8061.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8303.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52214 - OR36052214", "code_information": [ { "code": "52214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9695.91, "discounted_cash": 3834.0, "minimum": 168.15, "maximum": 9695.91, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6964.79, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7393.07, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8320.17, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7093.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.15 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7123.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8153.38, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8703.59, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 6326.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6709.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Diag Laparo Separate Proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12380.6, "discounted_cash": 6575.0, "minimum": 316.95, "maximum": 12380.6, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6773.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 8219.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12380.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1351.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6707.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11944.98, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12380.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9863.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 12380.6, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 9206.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9206.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12165.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9863.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9863.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 316.95 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 9206.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12217.87, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12380.6, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12380.6, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12380.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 7562.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 7562.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 10850.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 11507.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Elixir 0.5 Mg/5Ml", "drug_information": { "unit": 237.0, "type": "ML" }, "code_information": [ { "code": "64980050924", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.64, "10th_percentile": 0.48, "90th_percentile": 1.6, "count": "1 through 10" } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52224 - ", "code_information": [ { "code": "52224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5480.63, "discounted_cash": 3834.0, "minimum": 195.03, "maximum": 5480.63, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.03 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5480.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Dexamethasone Tab 4 Mg", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054418425", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.64, "10th_percentile": 0.48, "90th_percentile": 1.6, "count": "1 through 10" } ] } ] }, { "description": "Drain Bl W/Cath Insertion", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13701.3, "discounted_cash": 2273.0, "minimum": 48.04, "maximum": 13701.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 48.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.27 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.27 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.02 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52260 - ", "code_information": [ { "code": "52260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11645.74, "discounted_cash": 2273.0, "minimum": 201.51, "maximum": 11645.74, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.51 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Drain Lower Leg Lesion", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 377.12, "maximum": 8430.55, "payers_information": [ { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY CHEMODENERVATION", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 2273.0, "minimum": 565.94, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Drain Thigh/Knee Lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9695.91, "discounted_cash": 3159.0, "minimum": 479.04, "maximum": 9695.91, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.04 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5620.37, "discounted_cash": 3834.0, "minimum": 274.67, "maximum": 5620.37, "payers_information": [ { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.67 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Cap 25 Mg", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904530661", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 0.02, "90th_percentile": 1.4, "count": "1 through 10" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.45%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264761200", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6.0, "10th_percentile": 5.9, "90th_percentile": 6.0, "count": "17" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6.0, "10th_percentile": 5.9, "90th_percentile": 6.0, "count": "1 through 10" } ] } ] }, { "description": "Drain/Inj Joint/Bursa W/O Us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 333.0, "minimum": 44.58, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 84.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 606.49, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 643.79, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 724.52, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.58 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 620.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 710.0, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 757.91, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 383.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 383.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 550.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 584.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 343.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 417.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Cystouretero & Or Pyeloscope", "code_information": [ { "code": "52351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3834.0, "minimum": 289.07, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6964.79, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7393.07, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8320.17, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7093.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.07 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7123.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8153.38, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8430.55, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 6326.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6709.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Diphenhydramine Hcl Tab 50 Mg", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904205661", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 0.02, "90th_percentile": 1.4, "count": "1 through 10" } ] } ] }, { "description": "Cystouretero W/Stone Remove", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3834.0, "minimum": 338.8, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 842.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3910.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6964.79, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7393.07, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8320.17, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7093.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5751.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.8 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5367.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7123.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8153.38, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8703.59, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7668.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4409.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 6326.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6709.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 991.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3834.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3949.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4792.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7513.0, "minimum": 7513.77, "maximum": 15027.2, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13374.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7664.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11270.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12548.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9767.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10519.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13900.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11270.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11270.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10519.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12022.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11909.33, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11839.89 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15027.2 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11270.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8640.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8640.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10894.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11646.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7846.77 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7513.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7739.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7953.0, "minimum": 6520.61, "maximum": 16009.72, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14156.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8112.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11929.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13281.73, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10339.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11134.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14713.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11929.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11929.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11134.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12725.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12605.71, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12614.02 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 16009.72 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11929.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9146.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9146.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11532.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12327.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6520.61 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7953.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8191.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10951.0, "minimum": 10951.18, "maximum": 22714.08, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19493.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11170.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16426.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 18288.47, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14236.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10951.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 15331.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20259.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16426.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16426.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 15331.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17521.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17357.65, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 17896.36 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 22714.08 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16426.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12593.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12593.88, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 15879.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 16974.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12523.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11279.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9063.23, "discounted_cash": 758.0, "minimum": 120.97, "maximum": 9063.23, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1516.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 197.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 773.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1377.74, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 231.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.46, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1137.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1645.86, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1061.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 231.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1061.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1403.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1137.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1137.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.97 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1061.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1409.22, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1612.87, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1721.7, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1516.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 872.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 872.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1251.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1327.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 231.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 231.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 758.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 781.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 948.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14141.0, "minimum": 13787.7, "maximum": 29848.96, "payers_information": [ { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16263.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20505.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21919.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13787.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14566.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25172.32, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14424.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21212.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 23616.72, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18384.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14141.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19798.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26162.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21212.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21212.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19798.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22626.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22414.75, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 23517.92 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 29848.96 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21212.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16263.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12270.0, "minimum": 11010.8, "maximum": 25665.21, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21842.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12516.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18406.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 20492.35, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15952.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12270.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 17179.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22701.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18406.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 17179.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19633.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19449.38, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 20221.55 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 25665.21 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18406.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 14111.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 14111.54, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17792.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 19019.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11010.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12270.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12639.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Enalaprilat Iv Soln 1.25 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143978710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Diagnostic Sigmoidoscopy", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1011.0, "minimum": 21.04, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2023.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 21.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1031.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1837.44, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.11 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1950.43, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1517.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2195.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1416.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.11 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1416.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1871.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1517.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1517.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.31 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1416.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1879.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2151.02, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2296.17, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2023.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1163.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1163.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1669.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1770.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.11 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1041.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1264.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8982.0, "minimum": 8452.19, "maximum": 18310.6, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15988.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9161.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13473.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 15000.01, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11676.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12574.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16616.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13473.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13473.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12574.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14371.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14236.53, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 14426.88 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 18310.6 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13473.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10329.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10329.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 13023.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13922.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8452.19 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8982.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9251.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9880.0, "minimum": 4478.87, "maximum": 24755.4121, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17587.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10078.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14821.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 12844.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 13833.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18279.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14821.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14821.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 13833.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15809.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15660.97, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16010.31 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 20320.3 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14821.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11362.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11362.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14327.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15315.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4478.87 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9880.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10177.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8177.0, "minimum": 8177.61, "maximum": 16511.7, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12266.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13656.61, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10630.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11448.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15128.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12266.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12266.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11448.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13084.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12961.51, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13009.52 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 16511.7 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12266.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9404.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9404.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11857.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12675.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9146.16 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8422.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14556.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8341.16, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Dilation And Curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6822.57, "discounted_cash": 3521.0, "minimum": 213.88, "maximum": 6822.57, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6822.57, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 699.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3591.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6396.02, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6789.33, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6822.57, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6513.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.88 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6542.15, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6822.57, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6822.57, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6822.57, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5809.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6161.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3626.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4401.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Ephedrine Sulfate Inj 50 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641623801", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "DRAINAGE OF SCROTUM", "code_information": [ { "code": "54700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 2273.0, "minimum": 204.37, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2319.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4130.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4384.23, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4934.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3410.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.37 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3183.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4224.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4835.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5161.39, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4547.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2614.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3751.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3979.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 665.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2273.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2341.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2842.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Dbrdmt Bone 1St 20 Sq Cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1796.0, "minimum": 226.7, "maximum": 8430.55, "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 353.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.7 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17708.0, "minimum": 9559.6004, "maximum": 37825.23, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31521.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 18062.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26562.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 29573.33, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 23021.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17708.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 24792.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32760.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26562.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26562.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 24792.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28333.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28068.13, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 29802.41 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 37825.23 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26562.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 20364.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 20364.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25677.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 27448.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17708.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14676.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17708.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 18239.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Inj 50 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641037621", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.41, "10th_percentile": 0.78, "90th_percentile": 10.83, "count": "1 through 10" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 170349.0, "minimum": 170349.52, "maximum": 379166.97, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 303222.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 173756.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 255524.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 284483.7, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 221454.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 170349.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 238490.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 315146.61, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 255524.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 255525.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 238489.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 272559.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 270004.75, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 298744.69 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 379166.97 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 255524.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 195901.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 195902.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 247006.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 264041.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 170349.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 266203.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 170350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 175460.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Liquid 12.5 Mg/5Ml", "drug_information": { "unit": 118.0, "type": "ML" }, "code_information": [ { "code": "00904698520", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.4, "10th_percentile": 0.02, "90th_percentile": 1.4, "count": "1 through 10" } ] } ] }, { "description": "Decompress Spinal Cord Lmbr", "code_information": [ { "code": "63056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21577.5, "discounted_cash": 7892.0, "minimum": 495.63, "maximum": 21577.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4559.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14337.11, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15218.72, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 17127.18, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14601.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1444.41 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14664.66, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 16783.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 17916.45, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13022.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13812.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8129.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9865.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13943.0, "minimum": 13036.975, "maximum": 29405.93, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24819.68, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14222.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20915.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 23285.88, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18126.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13943.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19521.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25795.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20915.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20915.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19521.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22309.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22100.61, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 23168.86 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 29405.93 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20915.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16035.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16035.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 20218.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21612.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13943.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15265.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13943.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14361.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8505.0, "minimum": 8505.13, "maximum": 17244.12, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15139.13, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8675.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12757.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 14203.57, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11056.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11907.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15734.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12757.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12757.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11907.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13608.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13480.63, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13586.6 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17244.12 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12757.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9780.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9780.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12332.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13182.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9602.28 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8505.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8760.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Decompression of tibia nerve", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9676.69, "discounted_cash": 2124.0, "minimum": 347.74, "maximum": 9676.69, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4248.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 523.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2166.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3858.26, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4095.52, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4609.1, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2973.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2973.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3929.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.74 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2973.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3946.41, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4516.71, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4821.5, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4248.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2442.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2442.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3504.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3717.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2187.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2655.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6931.0, "minimum": 5302.56, "maximum": 66999.6514, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12337.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7070.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10397.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11575.47, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9010.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9703.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12823.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10397.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10397.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9703.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11090.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10986.3, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10813.82 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 13724.91 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10397.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7971.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7971.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10050.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10743.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5302.56 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6931.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7139.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15130.0, "minimum": 15130.7, "maximum": 32060.52, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26932.68, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 15433.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22696.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 25268.3, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 19669.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15130.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 21182.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27991.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22696.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22696.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 21183.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24209.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23982.16, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 25260.4 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 32060.52 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 22696.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 17400.33, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 17400.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 21939.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 23452.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15130.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18620.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15130.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 15584.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7021.0, "minimum": 6640.05, "maximum": 13926.77, "payers_information": [ { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11234.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11129.36, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10972.87 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 13926.77 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10532.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8074.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8074.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10181.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10883.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6640.05 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7232.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12498.59, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7162.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10532.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11726.21, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9128.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9830.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12990.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10532.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10532.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7021.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9830.35, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14508.0, "minimum": 14508.4, "maximum": 63870.1318, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25824.99, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14798.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21762.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 24229.06, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18860.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14508.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 20311.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26840.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21762.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21762.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 20311.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23213.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22995.81, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 24163.96 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 30668.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21762.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16684.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16684.66, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 21037.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 22488.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14508.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16641.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14508.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14943.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6383.0, "minimum": 6183.93, "maximum": 12499.44, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11362.47, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6511.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9575.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 10660.29, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8298.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8936.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11809.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9575.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9575.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8936.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10213.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10117.7, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 9848.28 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 12499.44 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9575.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7340.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7340.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9255.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9894.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6183.93 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6383.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6574.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8310.0, "minimum": 4723.91, "maximum": 16808.24, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14792.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8476.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12465.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13878.05, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10803.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11634.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15373.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12465.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12465.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11634.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13296.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13171.68, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13243.17 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 16808.24 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12465.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9556.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9556.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12049.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12880.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4723.91 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8310.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8559.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5757.0, "minimum": 5757.92, "maximum": 11100.69, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10249.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5873.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8636.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9615.73, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7485.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10652.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8636.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8636.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8061.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9212.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9126.3, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 8746.21 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11100.69 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8636.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6621.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6621.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8348.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 8924.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5897.69 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5757.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 5930.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EVACUATE MOLE UTERUS", "code_information": [ { "code": "59870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7500.0, "discounted_cash": 3521.0, "minimum": 466.38, "maximum": 7500.0, "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6513.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 466.38 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6542.15, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7487.56, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7500.0, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4049.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5809.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6161.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3626.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4401.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7042.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 699.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3591.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6396.02, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6789.33, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5281.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7500.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4929.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3521.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 1 Mg", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054418125", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.64, "10th_percentile": 0.48, "90th_percentile": 1.6, "count": "1 through 10" } ] } ] }, { "description": "Epinephrine Soln Prefilled Syringe 1 Mg/10Ml (0.1 Mg/Ml)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "76329331601", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 71.81, "10th_percentile": 71.81, "90th_percentile": 71.81, "count": "1 through 10" } ] } ] }, { "description": "EXC ABDL TUM DEEP 5 CM>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Dexmedetomidine Hcl In Nacl 0.9% Iv Soln 200 Mcg/50Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "70121138801", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "EXC FOREARM LES SC < 3 CM", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1686.11, "discounted_cash": 1796.0, "minimum": 305.77, "maximum": 1686.11, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.77 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Eravacycline Dihydrochloride Iv For Soln 50 Mg (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "71773005005", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Doxycycline Hyclate For Inj 100 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68382091001", "type": "NDC" }, { "code": "J1271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 60.4, "count": "1 through 10" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6483.85, "discounted_cash": 1796.0, "minimum": 44.72, "maximum": 6483.85, "payers_information": [ { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.33 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.77 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 44.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.77 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 2500 Mg/250Ml (10 Mg/Ml)", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "44567081110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Drain Hand Tendon Sheath", "code_information": [ { "code": "26020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3559.0, "minimum": 417.85, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 417.85 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1796.0, "minimum": 151.28, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 353.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.28 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Diazepam Inj 5 Mg/Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409127303", "type": "NDC" }, { "code": "J3360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 40.39, "10th_percentile": 40.39, "90th_percentile": 40.39, "count": "1 through 10" } ] } ] }, { "description": "Esmolol Hcl-Sodium Chloride Iv Soln 2500 Mg/250Ml", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "10019005561", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Drainage Of Finger Abscess", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 1796.0, "minimum": 178.45, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 353.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.45 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 1796.0, "minimum": 172.51, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.51 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Esomeprazole Sodium For Intravenous Soln 40 Mg (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "67457039299", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49750.0, "minimum": 35010.0, "maximum": 109477.74, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 88555.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 50745.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 74625.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 83082.65, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 64675.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 49750.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 69650.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 92037.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 74625.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 74625.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 69650.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 79600.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 78853.91, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 86257.23 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 109477.74 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 74625.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 57212.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 57212.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 72137.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 77112.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43249.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 49750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 51242.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 35010.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 63023.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 35010.0 } ] } ] }, { "description": "Exc hand les sc 1.5 cm>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6744.44, "discounted_cash": 1796.0, "minimum": 531.33, "maximum": 6744.44, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10456.0, "minimum": 10456.7, "maximum": 21608.29, "payers_information": [ { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14639.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16730.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16573.87, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 17025.12 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 21608.29 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15685.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12025.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12025.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 15162.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 16207.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11816.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10770.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18612.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10665.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15685.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 17462.69, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13593.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10456.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14639.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19344.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15685.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15685.05, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38825.0, "minimum": 4166.89, "maximum": 98016.9529, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 69108.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 39601.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 58237.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 64837.98, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 50472.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 38825.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 54355.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 71826.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 58237.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 58237.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 54355.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 62120.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 61537.78, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 67008.26 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 85046.93 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 58237.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 44648.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 44648.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 56296.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 60178.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38825.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4166.89 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 38825.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 39989.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10725.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 19308.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 10725.0 } ] } ] }, { "description": "EXC HIPPELV TUM DEEP 5 CM>", "code_information": [ { "code": "27045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17878.0, "minimum": 17878.7, "maximum": 38205.74, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31824.14, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 18236.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26818.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 29857.48, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 23242.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17878.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 25030.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 33075.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26818.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26818.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 25030.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28605.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28337.74, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 30102.2 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 38205.74 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26818.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 20560.54, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 20560.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 25924.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 27712.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22371.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17878.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 18415.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc 3 Cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Epinephrine Hcl Inj 1 Mg/Ml", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "42023016801", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 71.81, "10th_percentile": 71.81, "90th_percentile": 71.81, "count": "1 through 10" } ] } ] }, { "description": "Exc Ischial Pr Ulc Prim Sutr", "code_information": [ { "code": "15940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 678.81 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Diltiazem Hcl Iv Soln 50 Mg/10Ml (5 Mg/Ml)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "17478093710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "EXC FACE LES SBQ 2 CM<", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1796.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 } ] } ] }, { "description": "Exc rectal tumor endoscopic", "code_information": [ { "code": "0184T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16861.1, "discounted_cash": 6603.0, "minimum": 2083.48, "maximum": 16861.1, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13206.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2083.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6735.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11995.09, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12732.7, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9905.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 14329.4, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 9244.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9244.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12216.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9905.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9905.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 9244.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12269.14, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 14042.15, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 14989.74, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13206.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 7593.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 7593.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 10895.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 11555.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6603.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6801.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 8254.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16501.0, "minimum": 9019.0, "maximum": 35125.98, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29372.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16831.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24752.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 27557.56, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21451.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16501.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 23102.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30527.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24752.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24752.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 23102.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26402.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26154.88, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 27675.67 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 35125.98 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24752.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18976.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18976.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 23927.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25577.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16501.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12622.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16996.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg >4 cm", "code_information": [ { "code": "11646", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13152.42, "discounted_cash": 3159.0, "minimum": 383.67, "maximum": 13152.42, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 383.67 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc snhfg mal+mrg 1.1-2", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4742.46, "discounted_cash": 770.0, "minimum": 56.6, "maximum": 4742.46, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 56.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1399.16, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.2, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1671.44, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.7 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.93 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1431.12, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1637.94, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1748.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1270.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1347.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 793.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 962.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7402.0, "minimum": 6896.42, "maximum": 14778.89, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13176.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7550.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11104.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12362.56, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9623.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13695.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11104.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11104.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10363.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11844.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11733.33, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11644.25 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14778.89 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11104.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8513.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8513.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10733.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11474.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6896.42 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7402.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7624.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg >4 Cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 263.82, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.82 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc Tr-Ext Mal+Marg 3.1-4 Cm", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 770.0, "minimum": 207.55, "maximum": 8430.55, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1347.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 793.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 962.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 353.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1399.16, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.2, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1671.44, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.55 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1431.12, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1637.94, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1748.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1270.91, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "Exc Leg/Ankle Les Sc 3 Cm/>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Etomidate Iv Soln 2 Mg/Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150022110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Excision addl breast lesion", "code_information": [ { "code": "19126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3836.23, "minimum": 53.33, "maximum": 3836.23, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 53.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.37 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.37 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.42 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.37 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.37 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Exc legankle tum deep <5 cm", "code_information": [ { "code": "27619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10539.28, "discounted_cash": 3159.0, "minimum": 457.41, "maximum": 10539.28, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 457.41 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "EX ARMELBOW TUM DEEP 5 CM>", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2634.63, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 2634.63, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2634.63 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2634.63 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2634.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 2086.98, "10th_percentile": 2086.98, "90th_percentile": 2086.98, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2634.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 171350.0, "minimum": 91229.5713, "maximum": 381405.33, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 305003.84, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 174777.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 257025.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 286155.28, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 222755.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 171350.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 239890.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 316998.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 257025.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 257025.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 239890.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 274160.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 271589.75, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 300508.29 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 381405.33 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 257025.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 197053.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 197052.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 248458.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 265593.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 171350.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 271124.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 171350.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 176490.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXC SHOULDER LES SC 3 CM>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7025.58, "discounted_cash": 1796.0, "minimum": 531.33, "maximum": 7025.58, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "EXC ABD LES SC 3 CM>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6323.69, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 6323.69, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6323.69, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6323.69, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6323.69, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13755.0, "minimum": 13755.9, "maximum": 28986.13, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24485.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14031.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20633.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22972.37, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17882.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13755.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 19258.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25448.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20633.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20633.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 19258.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22009.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21803.1, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22838.1 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 28986.13 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20633.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15819.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15819.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19946.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 21321.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20630.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14168.59, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Drain Shoulder Lesion", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 3159.0, "minimum": 247.18, "maximum": 10961.3, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 247.18 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Tum Dep 5Cm/>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13027.4, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 13027.4, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "EXC BACK LES SC < 3 CM", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7868.52, "discounted_cash": 1796.0, "minimum": 352.69, "maximum": 7868.52, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 352.69 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Fluorescein Sodium Iv Soln 10%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00065009265", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [ { "code": "58800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2950.69, "discounted_cash": 3521.0, "minimum": 291.76, "maximum": 2950.69, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 699.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.76 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2950.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Exc tr-ext b9+marg 0.5 cm<", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5269.29, "discounted_cash": 770.0, "minimum": 26.3, "maximum": 5269.29, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 26.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1399.16, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.2, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1671.44, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.15 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.65 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1431.12, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1637.94, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1748.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1270.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1347.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 793.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 962.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "EXC FOREARM LES SC 3 CM>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1686.11, "discounted_cash": 1796.0, "minimum": 505.833, "maximum": 1686.11, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1686.11 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1686.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1686.11 } ] } ] }, { "description": "Fluphenazine Hcl Inj 2.5 Mg/Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323028110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Excise excess skin & tissue", "code_information": [ { "code": "15839", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.26, "discounted_cash": 3159.0, "minimum": 1001.72, "maximum": 10961.26, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1001.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXC FOREARM TUM DEEP 3 CM>", "code_information": [ { "code": "25073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2107.63, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 2107.63, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2107.63 } ] } ] }, { "description": "Excise Intrspinl Lesion Lmbr", "code_information": [ { "code": "63267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28496.0, "discounted_cash": 7892.0, "minimum": 461.19, "maximum": 28496.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 461.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3939.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14337.11, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1317.68 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15218.72, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 17127.18, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1317.68 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14601.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1344.03 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14664.66, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 16783.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 17916.45, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13022.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13812.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1317.68 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1317.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8129.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9865.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Exc S/N/H/F/G Mal+Mrg 0.6-1", "code_information": [ { "code": "11621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 770.0, "minimum": 49.39, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 49.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1399.16, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.2, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1671.44, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.1 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.92 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1431.12, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1637.94, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1748.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1270.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1347.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 793.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 962.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Dstr Mal Les S/N/H/F/G 2.1-3", "code_information": [ { "code": "17273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 442.0, "minimum": 47.82, "maximum": 8430.55, "payers_information": [ { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 821.55, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 940.27, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1003.73, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 508.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 508.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 729.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 773.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 455.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 552.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 47.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 451.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 803.2, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.59, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 959.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.63 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 139.36 } ] } ] }, { "description": "Excision Of Tongue Lesion", "code_information": [ { "code": "41112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3606.0, "minimum": 251.27, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7212.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 607.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3678.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6550.81, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6953.63, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7825.63, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 251.27 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6700.47, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7668.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8186.26, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7212.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4147.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4147.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5950.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6310.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3714.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4507.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11802.8, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 11802.8, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6798.0, "minimum": 6798.01, "maximum": 16847.5322, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12100.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6933.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10197.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11352.68, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8837.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9517.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12576.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10197.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10197.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9517.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10876.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10774.85, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10578.77 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 13426.58 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10197.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7817.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7817.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9857.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10536.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7907.51 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7001.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Expl Pentrg Wound Extremity", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15021.2, "discounted_cash": 1796.0, "minimum": 338.39, "maximum": 15021.2, "payers_information": [ { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.39 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 353.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" } ] } ] }, { "description": "Exc skn hdrdnt ax smplntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 242.02, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.02 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12175.0, "minimum": 11389.8645, "maximum": 25452.63, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21672.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12419.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18263.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 20333.6, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15828.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12175.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 17046.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22525.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18263.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18263.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 17046.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19481.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19298.64, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 20054.06 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 25452.63 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18263.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 14002.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 14002.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17654.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18872.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12175.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13398.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12175.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12541.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7161.0, "minimum": 7161.48, "maximum": 14239.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12747.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7304.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10742.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11959.67, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9309.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10026.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13248.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10742.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10026.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11458.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11350.95, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11219.18 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14239.39 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10742.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8235.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8235.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10384.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11100.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9151.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7161.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7376.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exploration Of Toe Joint", "code_information": [ { "code": "28024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1749.0, "minimum": 294.84, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3498.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1784.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3177.13, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3372.5, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3795.42, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2448.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3235.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.84 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2448.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3249.72, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3719.33, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3970.32, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3498.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2011.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2011.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2885.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3060.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1801.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2186.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc snhfg mal+mrg >4 cm", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2107.75, "discounted_cash": 3159.0, "minimum": 284.91, "maximum": 2107.75, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2107.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.91 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2107.75 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2107.75 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2107.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34102.0, "minimum": 12516.1, "maximum": 74485.73, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 60702.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 34784.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 51153.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 56950.99, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 44333.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34102.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 47743.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 63089.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 51153.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 51153.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 47743.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 54563.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 54052.3, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 58687.12 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 74485.73 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 51153.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 39217.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 39217.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 49448.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 52858.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34102.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47664.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 35125.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Endocervical Curettage", "code_information": [ { "code": "57505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1001.0, "minimum": 30.81, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 30.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1021.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1819.84, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1931.75, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2173.99, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.04 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1853.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1502.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.8 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1402.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1861.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2130.41, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2274.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2003.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1152.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1653.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1753.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1001.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1031.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1252.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Explore limb vessels", "code_information": [ { "code": "35860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5043.81, "discounted_cash": 3434.0, "minimum": 288.73, "maximum": 5043.81, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 824.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 824.95 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 841.45 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 824.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 824.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3537.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4293.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5043.81, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 288.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Exc snhfg mal+mrg 2.1-3", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1796.0, "minimum": 70.17, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 70.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.48 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.48 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.49 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.48 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58092.0, "minimum": 35423.2, "maximum": 128133.11, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 103404.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 59254.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 87138.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 97014.29, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 75520.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 58092.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 81329.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 107470.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 87138.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 87138.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 81329.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 92947.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 92076.45, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 100955.75 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 128133.11 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 87138.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 66806.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 66806.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 84233.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 90043.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58092.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35423.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 58092.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 59835.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOSCOPY MAXILLARY SINUS", "code_information": [ { "code": "31267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2192.18, "discounted_cash": 7676.0, "minimum": 307.86, "maximum": 2192.18, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2192.18 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2192.18 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1152.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2192.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1355.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1355.35 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.86 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1355.35 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1355.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2192.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20433.0, "minimum": 20433.4, "maximum": 43918.64, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 36371.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 20842.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30650.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 34123.83, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 26563.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20433.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 28606.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 37801.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30650.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30650.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 28606.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32693.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 32386.94, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 34603.39 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 43918.64 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30650.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 23498.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 23498.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 29628.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 31671.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20433.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24474.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 21046.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Les Sc 3 Cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9133.22, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 9133.22, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "FUSION OF FINGER JOINT", "code_information": [ { "code": "26860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10260.32, "discounted_cash": 3559.0, "minimum": 534.97, "maximum": 10260.32, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.97 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Famotidine Inj 20 Mg/2Ml", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323073806", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "1 through 10" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8936.69, "discounted_cash": 1796.0, "minimum": 236.66, "maximum": 8936.69, "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 236.66 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15396.0, "minimum": 15396.7, "maximum": 32655.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27406.18, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 15704.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23095.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 25712.54, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 20015.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15396.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 21555.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28483.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23095.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23095.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 21555.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24634.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24403.77, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 25729.1 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 32655.39 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23095.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 17706.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 17706.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 22325.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 23864.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15396.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17442.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15396.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 15858.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9695.91, "discounted_cash": 770.0, "minimum": 37.71, "maximum": 9695.91, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 37.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1399.16, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.2, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1671.44, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.88 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1431.12, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1637.94, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1748.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1270.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1347.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 793.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 962.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5829.0, "minimum": 5829.81, "maximum": 11261.47, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10377.06, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5946.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8744.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 9735.78, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 7578.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 8161.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10785.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8744.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8744.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 8161.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9327.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9240.25, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 8872.88 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 11261.47 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8744.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 6704.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 6704.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 8453.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 9036.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7025.13 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5829.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6004.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg 1.1-2 cm", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6323.3, "discounted_cash": 442.0, "minimum": 157.16, "maximum": 6323.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 193.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 451.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 803.2, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.59, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 959.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.16 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 821.55, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 940.27, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1003.73, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 508.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 508.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 729.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 773.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 455.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 552.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7103.0, "minimum": 5946.08, "maximum": 14108.99, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12643.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7245.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10654.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11862.29, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9234.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9944.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13140.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10654.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10654.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9944.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11365.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11258.52, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11116.44 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14108.99 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10654.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8168.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8168.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10299.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11009.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5946.08 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7103.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7316.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Epinephrine Solution Auto-Injector 0.3 Mg/0.3Ml (1:1000)", "drug_information": { "unit": 2.0, "type": "EA" }, "code_information": [ { "code": "00093598627", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 71.81, "10th_percentile": 71.81, "90th_percentile": 71.81, "count": "1 through 10" } ] } ] }, { "description": "Flumazenil Iv Soln 0.5 Mg/5Ml (0.1 Mg/Ml)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323042405", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "Excise/Repair Mouth Lesion", "code_information": [ { "code": "40812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1687.0, "minimum": 67.07, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3375.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 67.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1721.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3065.67, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3254.18, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3662.27, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2362.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.62 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2362.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3122.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.45 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2362.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3135.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3588.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3831.03, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3375.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1940.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1940.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2784.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2953.44, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.62 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1738.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2109.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12591.0, "minimum": 12591.2, "maximum": 26381.56, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22412.34, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12843.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18886.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 21027.3, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 16368.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23293.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18886.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18886.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 17627.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20145.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19957.05, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 20785.96 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 26381.56 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18886.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 14479.88, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 14479.88, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 18257.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 19516.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12883.7 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12591.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12968.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11430.0, "minimum": 9389.1658, "maximum": 23785.92, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20346.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11659.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17145.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 19088.92, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14859.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11430.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16002.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21146.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17145.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17145.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16002.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18288.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18117.34, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 18740.86 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 23785.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17145.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13145.06, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13145.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16574.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 17717.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15796.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11773.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Excision Breast Lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.3, "discounted_cash": 4258.0, "minimum": 440.43, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 821.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4344.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7736.26, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8211.97, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 9241.77, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7878.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 440.43 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7913.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 9056.51, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 9667.66, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4897.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7027.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 7453.04, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 4386.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6657.0, "minimum": 5127.53, "maximum": 22281.4385, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11850.19, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 6790.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9986.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 11117.87, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 8654.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12316.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9986.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9986.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 9320.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10651.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10551.99, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 10331.05 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 13112.18 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9986.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 7656.02, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 7656.02, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 9653.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 10318.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5127.53 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6657.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 6857.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Excision Of Uvula", "code_information": [ { "code": "42140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3606.0, "minimum": 154.17, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7212.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 607.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3678.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6550.81, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6953.63, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7825.63, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5409.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.17 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5048.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6700.47, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7668.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8186.26, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7212.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4147.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4147.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5950.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6310.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3606.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3714.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4507.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exploration of knee joint", "code_information": [ { "code": "27310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5620.37, "discounted_cash": 3559.0, "minimum": 708.46, "maximum": 5620.37, "payers_information": [ { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 708.46 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5620.37, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Grfg autol fat lipo ea addl", "code_information": [ { "code": "15772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1972.86, "minimum": 46.67, "maximum": 1972.86, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 46.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.01 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1972.86 } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15725.0, "minimum": 15725.86, "maximum": 33391.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27992.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16040.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23588.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 26262.19, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 20443.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15725.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 22016.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29092.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23588.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23588.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 22016.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25161.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24925.55, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 26308.99 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 33391.39 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23588.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18084.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18084.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 22802.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 24375.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15725.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19597.9 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16197.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38273.0, "minimum": 31269.6615, "maximum": 83814.32, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 68127.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 39039.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 57410.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 63917.48, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 49756.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 38273.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 53583.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 70806.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 57410.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 57410.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 53583.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 61238.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 60664.13, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 66037.09 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 83814.32 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 57410.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 44015.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 44014.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 55497.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 59324.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38273.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57636.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 38273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 39422.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7245.0, "minimum": 6561.8, "maximum": 14426.97, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12896.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7390.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10868.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12099.75, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9418.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10143.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13403.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10868.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10868.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10143.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11592.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11483.9, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11366.97 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14426.97 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10868.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8332.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8332.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10505.77, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11230.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6561.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7245.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7462.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13055.0, "minimum": 13055.3, "maximum": 27419.45, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23238.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13316.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19583.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 21802.4, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 16971.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13055.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18277.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24152.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19583.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19582.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18277.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20888.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20692.65, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 21603.72 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 27419.45 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19583.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15013.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15013.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 18930.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 20235.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13055.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23974.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13055.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13446.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 100 Mg/10Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150019410", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 21.0, "10th_percentile": 5.45, "90th_percentile": 70.5, "count": "43" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 12.6, "10th_percentile": 9.2, "90th_percentile": 326.74, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 31.26, "10th_percentile": 5.45, "90th_percentile": 326.74, "count": "1 through 10" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26522.0, "minimum": 17939.1, "maximum": 57536.37, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 47210.92, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 27053.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39784.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 44293.39, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 34479.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26522.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 37132.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 49067.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 39784.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 39784.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 37132.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 42436.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 42038.96, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 45332.76 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 57536.37 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 39784.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 30501.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 30501.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 38458.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 41110.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26522.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17939.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26523.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 27318.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48273.0, "minimum": 7562.6, "maximum": 106174.68, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 85925.99, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 49238.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 72409.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 80615.96, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 62754.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 48273.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 67582.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 89305.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 72409.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 72409.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 67582.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 77236.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 76512.71, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 83654.76 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 106174.68 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 72409.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 55513.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 55513.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 69995.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 74823.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48273.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7562.6 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 48273.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 49721.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8960.0, "minimum": 8960.47, "maximum": 45416.5119, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15949.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 9139.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13440.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 14963.98, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11648.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12544.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16576.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13440.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13440.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12544.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14336.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14202.34, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 14388.87 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 18262.37 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13440.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 10304.54, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 10304.54, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12992.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13888.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10027.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8960.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 9229.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10925.0, "minimum": 10663.8, "maximum": 22656.91, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19447.6, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11144.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16388.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 18245.79, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14203.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10925.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 15295.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20212.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16388.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16388.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 15295.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17480.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17317.08, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 17851.32 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 22656.91 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16388.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12564.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12564.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 15842.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 16934.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10925.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10663.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10925.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11253.39, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28750 - OR36028750", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11802.8, "discounted_cash": 7892.0, "minimum": 578.45, "maximum": 11802.8, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8129.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9865.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1670.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1965.14 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 578.45 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 11802.8, "additional_payer_notes": "175.00% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 100 Mcg/2Ml", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409909416", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6.74, "10th_percentile": 3.37, "90th_percentile": 16.85, "count": "35" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN COMMERCIAL", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.0, "median_amount": 2.62, "10th_percentile": 2.62, "90th_percentile": 10.1, "count": "1 through 10" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 5.98, "10th_percentile": 3.44, "90th_percentile": 25.1, "count": "1 through 10" } ] } ] }, { "description": "Hc Car Outp Meas Drg Car Cath Eval Cgen Hrt Defect", "code_information": [ { "code": "93598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 914.64, "minimum": 22.54, "maximum": 914.64, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.4 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 914.64 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.4 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.69 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 914.64 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.4 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 914.64 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 914.64 } ] } ] }, { "description": "Hc Cysto W/Ureteroscopy W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5298.05, "discounted_cash": 5832.0, "minimum": 374.35, "maximum": 12179.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 1171.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 374.35 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1378.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5298.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "EX ARMELBOW TUM DEEP < 5 CM", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2810.18, "discounted_cash": 3159.0, "minimum": 524.94, "maximum": 2810.18, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 524.94 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2810.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5139.0, "minimum": 4406.79, "maximum": 9718.02, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 9148.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 5242.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7709.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 8583.17, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 6681.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 7195.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 9508.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7709.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7709.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 7195.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8223.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 8146.3, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 7656.8 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 9718.02 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7709.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 5910.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 5910.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 7452.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 7966.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4406.79 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5139.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 5293.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7885.0, "minimum": 6503.11, "maximum": 21352.2733, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14035.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8042.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11827.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13168.33, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10250.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11039.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14587.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11827.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11827.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11039.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12616.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12498.09, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12494.38 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15857.87 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11827.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9068.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9068.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11433.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12222.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6503.11 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7885.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8121.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc Education&Training Self-Mgmt Nonphys 1 Pt", "code_information": [ { "code": "98960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.84, "minimum": 8.66, "maximum": 131.84, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 131.84 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 131.84 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 131.84 } ] } ] }, { "description": "EXAM OF VAGINA WSCOPE", "code_information": [ { "code": "57420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.26, "discounted_cash": 331.0, "minimum": 30.48, "maximum": 10961.26, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.1, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 639.12, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 719.27, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 615.85, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 704.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 752.41, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 381.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 381.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 546.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 580.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 341.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 414.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11002.6, "discounted_cash": 1749.0, "minimum": 145.88, "maximum": 11002.6, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3498.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 411.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1784.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3177.13, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3372.5, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3795.42, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2448.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3235.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.88 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2448.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3249.72, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3719.33, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3970.32, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3498.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2011.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2011.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2885.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3060.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1801.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2186.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Hc Low Cost Skin Substitute App", "code_information": [ { "code": "C5275", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2559.65, "discounted_cash": 651.0, "minimum": 214.25, "maximum": 2559.65, "payers_information": [ { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 814.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2559.65 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1303.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 214.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 664.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1183.81, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1256.61, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2559.65 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 977.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1414.19, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 912.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1205.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 977.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 977.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 912.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1210.86, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1385.84, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1479.36, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1303.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2559.65 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 749.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 749.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1075.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1140.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2559.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 651.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 671.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 } ] } ] }, { "description": "Exc Abd Les Sc < 3 Cm", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1796.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15251.8, "discounted_cash": 3526.0, "minimum": 102.54, "maximum": 15251.8, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7052.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 102.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6862.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3596.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6405.52, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6799.41, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5289.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7652.07, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4936.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.96 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4936.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6523.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5289.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5289.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.82 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4936.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6551.87, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7498.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8004.7, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7052.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4055.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4055.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5818.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6171.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3632.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4407.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Exc Back Les Sc 3 Cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1796.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Gentamicin Sulfate Inj 40 Mg/Ml - 00409120713", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409120713", "type": "NDC" }, { "code": "J1580", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 44.54, "10th_percentile": 44.54, "90th_percentile": 44.54, "count": "1 through 10" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7947.0, "minimum": 7572.89, "maximum": 21997.8436, "payers_information": [ { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 12604.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 15997.21 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11921.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9139.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9139.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 11523.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 12318.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7572.89 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8185.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14146.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8106.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11921.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 13272.39, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 10331.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 11126.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14702.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11921.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11921.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7947.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 11126.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12716.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12596.85, "additional_payer_notes": "158.50% of Medicare Rates" } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.45, "minimum": 3.24, "maximum": 148.45, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.72 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.72 } ] } ] }, { "description": "Exc Back Tum Deep < 5 Cm", "code_information": [ { "code": "21932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13317.0, "minimum": 10252.7859, "maximum": 28005.39, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23704.88, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13583.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19976.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22239.97, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17312.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13317.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18644.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24637.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19976.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19976.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18644.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21307.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21108.08, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22065.38 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 28005.39 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19976.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15314.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15315.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19310.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 20641.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17427.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13317.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13716.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc hand les sc < 1.5 cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2107.63, "discounted_cash": 1796.0, "minimum": 320.61, "maximum": 2107.63, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 320.61 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2107.63 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2107.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13370.0, "minimum": 13002.6337, "maximum": 28123.3, "payers_information": [ { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21392.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21191.61, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 22158.27 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 28123.3 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20055.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 15375.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 15375.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 19386.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 20723.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16000.4 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 13771.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23798.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 13637.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20055.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 22328.02, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 17381.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13370.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 18718.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24734.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20055.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20055.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 13370.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 18718.1, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11035.0, "minimum": 10271.8644, "maximum": 22901.65, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19642.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 11255.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16552.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 18428.55, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 14345.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11035.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 15449.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20414.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16552.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16552.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 15449.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17656.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17490.63, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 18044.15 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 22901.65 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16552.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 12690.32, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 12690.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 16000.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 17104.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11035.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15199.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11035.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 11366.11, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXC HIP PELVIS LES SC 3 CM>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10538.55, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 10538.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16485.0, "minimum": 16485.5, "maximum": 54713.8643, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29344.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 16815.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24728.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 27530.87, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 21431.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16485.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 23079.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30498.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24728.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24728.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 23079.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26376.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26129.52, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 27647.52 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 35090.26 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24728.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 18958.38, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 18958.33, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 23904.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 25552.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19169.5 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 16980.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18453.0, "minimum": 3747.83, "maximum": 39490.16, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32846.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 18822.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27679.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 30816.68, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 23989.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 25834.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34138.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27679.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27679.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 25834.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29524.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 29248.16, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 31114.2 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 39490.16 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 27679.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 21221.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 21221.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 26757.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 28602.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3747.83 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18453.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 19006.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Tum Deep 5 Cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10116.7, "discounted_cash": 3159.0, "minimum": 531.33, "maximum": 10116.7, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5739.23, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6092.15, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6856.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5870.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6718.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7172.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3633.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5213.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5529.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3254.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3949.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Hc Drug Assay Felbamate", "code_information": [ { "code": "80167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.2, "discounted_cash": 18.0, "minimum": 3.26, "maximum": 93.2, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 40.45, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.51 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 34.63, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 39.64, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 42.31, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of ankle joint open", "code_information": [ { "code": "27870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7671.95, "discounted_cash": 13964.0, "minimum": 1006.24, "maximum": 7671.95, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 5298.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1006.24 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7671.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Exc Rect Tum Transanal Full", "code_information": [ { "code": "45172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10959.7, "discounted_cash": 3019.0, "minimum": 874.09, "maximum": 10959.7, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4981.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5283.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3109.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2432.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 3644.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3773.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 874.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3079.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5484.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5821.49, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6551.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5585.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5609.54, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6420.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6853.43, "additional_payer_notes": "227.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myocardial Perfusion Planar 1 Study Rest/Stress", "code_information": [ { "code": "78453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1616.07, "discounted_cash": 1408.0, "minimum": 87.3, "maximum": 1616.07, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 400.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 681.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1436.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.08 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.62 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1450.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1616.07 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 1616.07 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 1616.07 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1616.07, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28755 - OR36028755", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10538.5, "discounted_cash": 7892.0, "minimum": 321.09, "maximum": 10538.5, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.09 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9076.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10538.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8129.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9865.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Exc Rect Tum Transanal Part", "code_information": [ { "code": "45171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 3019.0, "minimum": 874.09, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 874.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3079.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5484.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5821.49, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6551.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7734.0, "10th_percentile": 7734.0, "90th_percentile": 7734.0, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5585.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5609.54, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6420.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6853.43, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4981.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5283.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1028.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3109.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3773.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Hc Prgrmg Dev Eval Scrms Phys/Qhp In Person", "code_information": [ { "code": "93285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.45, "discounted_cash": 40.0, "minimum": 4.95, "maximum": 186.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 73.73, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.27, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 88.08, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 56.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.14, "10th_percentile": 108.14, "90th_percentile": 108.14, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 56.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 75.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 86.31, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 92.14, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 66.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 71.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 186.45 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 186.45 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 186.45 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 50.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.79 } ] } ] }, { "description": "Fusion of finger tendons", "code_information": [ { "code": "26471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1053.81, "discounted_cash": 3559.0, "minimum": 316.143, "maximum": 1053.81, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 585.17 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1053.81 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1053.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1053.81 } ] } ] }, { "description": "Exc Shoulder Les Sc < 3 Cm", "code_information": [ { "code": "23075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 1796.0, "minimum": 315.19, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 531.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 315.19 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "FUSION OF KNUCKLE", "code_information": [ { "code": "26850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1475.34, "discounted_cash": 7892.0, "minimum": 442.602, "maximum": 1475.34, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 900.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1475.34 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 658.26 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1475.34, "additional_payer_notes": "227.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 2.1-3Cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8430.55, "discounted_cash": 770.0, "minimum": 48.58, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 48.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1399.16, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.2, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1671.44, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.58 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1431.12, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1637.94, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1748.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 885.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1270.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1347.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 793.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 962.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Exc tr-ext b9+marg 3.1-4 cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5620.37, "discounted_cash": 1796.0, "minimum": 155.41, "maximum": 5620.37, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 353.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3463.93, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3898.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.41 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3337.82, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4077.96, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2065.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 2964.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3143.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1850.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2245.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Excise oral mucosa for graft", "code_information": [ { "code": "40818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7306.47, "discounted_cash": 586.0, "minimum": 117.56, "maximum": 7306.47, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 117.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 598.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1065.61, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 138.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1131.14, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 879.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1272.99, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 821.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 138.31 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1085.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 879.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 879.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.04 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 821.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1089.96, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1247.47, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1331.65, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 674.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 674.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 967.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1026.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 138.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 138.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 604.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 733.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Excision Of Anal Lesion(S)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9274.12, "discounted_cash": 3019.0, "minimum": 131.44, "maximum": 9274.12, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 624.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3079.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5484.25, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5821.49, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 6551.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5585.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4528.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.44 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4226.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5609.54, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 6420.18, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 6853.43, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6038.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3472.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4981.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5283.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 734.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3019.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3109.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3773.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Gentamicin Sulfate Inj 40 Mg/Ml - 63323001002", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323001002", "type": "NDC" }, { "code": "J1580", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 44.54, "10th_percentile": 44.54, "90th_percentile": 44.54, "count": "1 through 10" } ] } ] }, { "description": "EXPLORATION MAXILLARY SINUS", "code_information": [ { "code": "31256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3288.27, "discounted_cash": 4055.0, "minimum": 191.88, "maximum": 3288.27, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 748.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 880.4 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 880.4 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.88 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 880.4 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 880.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 3288.27, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 Mg/2Ml (0.2 Mg/Ml)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00517460225", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 57.5, "10th_percentile": 6.0, "90th_percentile": 115.0, "count": "1 through 10" } ] } ] }, { "description": "Explore Parathyroid Glands", "code_information": [ { "code": "60500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16441.0, "discounted_cash": 6439.0, "minimum": 321.0, "maximum": 16441.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12878.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 321.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5471.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6567.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11696.61, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 917.13 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12415.85, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9658.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 13972.83, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 9014.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 917.13 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9014.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11912.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9658.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9658.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 935.47 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 9014.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11963.83, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 13692.72, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 14616.73, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12878.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 7404.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 7404.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 10624.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 11268.41, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 917.13 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 917.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6439.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6632.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 2766.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4145.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 8048.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Grfg autol fat lipo 50 cc<", "code_information": [ { "code": "15771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1972.86, "discounted_cash": 3854.0, "minimum": 458.3, "maximum": 1972.86, "payers_information": [ { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 803.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1972.86 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.3 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1972.86, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31902.0, "minimum": 28116.6214, "maximum": 69565.99, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 56786.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 32540.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 47853.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 53276.99, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 41473.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 31902.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 44663.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 59019.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47853.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 47853.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 44663.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 51043.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 50565.3, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 54810.87 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 69565.99 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 47853.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 36687.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 36687.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 46258.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 49448.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31902.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49451.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 31902.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 32859.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14486.0, "minimum": 13076.2, "maximum": 48858.1284, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25785.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 14775.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21729.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 24191.7, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 18831.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14486.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 20280.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26799.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21729.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21729.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 20280.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23177.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22960.31, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 24124.55 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 30618.9 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21729.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 16658.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 16658.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 21004.77, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 22453.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14486.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13076.2 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14486.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 14920.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27092.0, "minimum": 27092.56, "maximum": 58810.07, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 48224.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 27634.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 40638.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 45244.58, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 35220.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 27092.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 37929.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 50121.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 40638.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 37929.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43348.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 42941.77, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 46336.31 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 58810.07 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 40638.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 31156.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 31156.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 39284.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 41993.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27092.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46921.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 27092.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 27905.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insertion Uterine Tandem&/Vaginal Ovoids", "code_information": [ { "code": "57155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5144.67, "discounted_cash": 5441.0, "minimum": 276.03, "maximum": 8722.56, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1283.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 1925.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 699.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.03 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 822.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5144.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10184.0, "minimum": 10184.3, "maximum": 20999.13, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18128.05, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 10387.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15276.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 17007.78, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 13239.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 14258.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18840.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15276.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15276.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 14258.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16294.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16142.12, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 16545.16 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 20999.13 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15276.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 11711.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 11711.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 14767.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 15785.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16857.0 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10184.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 10489.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc Irrigation Vagina&/Appl Medicament Tx Disease", "code_information": [ { "code": "57156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1434.79, "discounted_cash": 331.0, "minimum": 94.26, "maximum": 1434.79, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 94.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1434.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.1, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 639.12, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 719.27, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 615.85, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 704.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 752.41, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 381.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 381.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 546.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 580.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 110.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 341.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 414.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11876.0, "minimum": 11876.2, "maximum": 36590.8676, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21139.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 12113.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17814.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12228.0, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 15439.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11876.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 16626.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21971.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17814.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17814.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 16626.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19001.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18823.78, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 19526.25 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 24782.73 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17814.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 13657.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 13657.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 17220.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 18408.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11876.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19854.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11876.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 12232.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4213) 20+ Cc Syringe Only", "code_information": [ { "code": "A4213", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 43.96, "median_amount": 2.2, "10th_percentile": 2.2, "90th_percentile": 2.2, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 43.96, "median_amount": 15.85, "10th_percentile": 2.2, "90th_percentile": 18.05, "count": "1 through 10" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23090.0, "minimum": 23090.37, "maximum": 49860.21, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 41100.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 23552.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 34635.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 38560.92, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 30017.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 23090.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 32326.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 42717.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34635.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 34635.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 32326.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 36944.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 36598.28, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 39284.73 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 49860.21 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 34635.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 26553.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 26553.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 33481.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 35790.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30247.3 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 23090.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 23783.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15115.0, "minimum": 14762.8, "maximum": 32026.58, "payers_information": [ { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 21161.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27963.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22673.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22673.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 21161.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24184.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23958.07, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 25233.66 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 32026.58 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 22673.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 17382.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 17382.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 21917.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 23429.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14762.8 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 15569.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26905.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 15417.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22673.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 25242.95, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 19650.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15115.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 15115.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7233.0, "minimum": 5345.81, "maximum": 18269.782, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12875.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 7378.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10850.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 12079.74, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 9403.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 10126.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13381.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10850.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10850.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 10126.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11573.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11464.91, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 11345.86 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 14400.17 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10850.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 8318.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 8318.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 10488.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 11211.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5345.81 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 7450.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Furosemide Inj 10 Mg/Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "64679075903", "type": "NDC" }, { "code": "J1938", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.62, "10th_percentile": 1.62, "90th_percentile": 3.56, "count": "1 through 10" } ] } ] }, { "description": "Fusion of foot bones - 28725 - ", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9019.67, "discounted_cash": 13964.0, "minimum": 751.37, "maximum": 9019.67, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 2373.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 751.37 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9019.67, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Fusion of foot bones - 28730 - ", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12860.09, "discounted_cash": 13964.0, "minimum": 715.05, "maximum": 12860.09, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 2373.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 715.05 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 12860.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Fusion of foot bones - 28740 - ", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5366.11, "discounted_cash": 7892.0, "minimum": 610.56, "maximum": 5366.11, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 2373.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 610.56 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 3187.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 4776.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5366.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Gadoterate Meglumine Iv Soln 10 Mmol/20Ml (0.5 Mmol/Ml)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00407294322", "type": "NDC" }, { "code": "A9575", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 150.0, "10th_percentile": 1.4, "90th_percentile": 264.0, "count": "36" }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 263.99, "10th_percentile": 1.4, "90th_percentile": 326.7, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4557) Lead Wires, Pair", "code_information": [ { "code": "A4557", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 43.96, "median_amount": 65.94, "10th_percentile": 65.94, "90th_percentile": 65.94, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8628.0, "minimum": 8628.15, "maximum": 17519.22, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15358.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "case rate", "standard_charge_dollar": 8800.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12942.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "case rate", "standard_charge_dollar": 14409.01, "additional_payer_notes": "167.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "case rate", "standard_charge_dollar": 11216.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "case rate", "standard_charge_dollar": 12079.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15962.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12942.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12942.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "case rate", "standard_charge_dollar": 12079.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13805.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13675.62, "additional_payer_notes": "158.50% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "case rate", "standard_charge_dollar": 13803.35 }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "case rate", "standard_charge_dollar": 17519.22 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12942.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "case rate", "standard_charge_dollar": 9922.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "case rate", "standard_charge_dollar": 9922.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "case rate", "standard_charge_dollar": 12510.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "case rate", "standard_charge_dollar": 13373.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9005.1 }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8628.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "case rate", "standard_charge_dollar": 8886.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4559) Coupling Gel Or Paste", "code_information": [ { "code": "A4559", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 840.46, "10th_percentile": 840.46, "90th_percentile": 1858.94, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4556) Electrodes, Pair", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 43.96, "median_amount": 92.81, "10th_percentile": 92.81, "90th_percentile": 92.81, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800080", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "additional_payer_notes": "165.00% of Medicare Rates", "median_amount": 1638.0, "10th_percentile": 1638.0, "90th_percentile": 1638.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4657) Syringe W/Wo Needle", "code_information": [ { "code": "A4657", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 43.96, "median_amount": 4.4, "10th_percentile": 4.4, "90th_percentile": 6.59, "count": "1 through 10" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 476.5, "10th_percentile": 405.49, "90th_percentile": 1145.7, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6448) Lt Compres Band <3/Yd - A6448 - 27090038", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 154.57, "10th_percentile": 154.57, "90th_percentile": 154.57, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800001", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "additional_payer_notes": "165.00% of Medicare Rates", "median_amount": 1638.0, "10th_percentile": 1638.0, "90th_percentile": 1638.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6457) Tubular Dressing - A6457 - 27090041", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6448) Lt Compres Band <3/Yd - A6448 - 27100024", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 154.57, "10th_percentile": 154.57, "90th_percentile": 154.57, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6457) Tubular Dressing - A6457 - RU272066", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1788) Port Indwelling", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.0, "median_amount": 1300.52, "10th_percentile": 1300.52, "90th_percentile": 1300.52, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "additional_payer_notes": "165.00% of Medicare Rates", "median_amount": 951.6, "10th_percentile": 951.6, "90th_percentile": 951.6, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1821) Interspinous Implant", "code_information": [ { "code": "C1821", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.0, "median_amount": 20504.06, "10th_percentile": 20504.06, "90th_percentile": 20504.06, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1747) Endo, Single, Urinary Tract", "code_information": [ { "code": "C1747", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 5925.0, "10th_percentile": 5925.0, "90th_percentile": 5925.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1713) Anchr/Screw Oppos Bn-Bn/Sft Tiss-Bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.9, "median_amount": 4987.78, "10th_percentile": 4987.78, "90th_percentile": 6980.54, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.0, "median_amount": 8245.67, "10th_percentile": 1624.05, "90th_percentile": 37121.6, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "additional_payer_notes": "165.00% of Medicare Rates", "median_amount": 8475.0, "10th_percentile": 8475.0, "90th_percentile": 8475.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1776) Joint Device", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.0, "median_amount": 20504.06, "10th_percentile": 20504.06, "90th_percentile": 40025.16, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1762) Connective Tissue Human", "code_information": [ { "code": "C1762", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "additional_payer_notes": "165.00% of Medicare Rates", "median_amount": 7410.0, "10th_percentile": 7410.0, "90th_percentile": 7410.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1763) Conn Tiss, Non-Human", "code_information": [ { "code": "C1763", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.0, "median_amount": 16892.0, "10th_percentile": 16892.0, "90th_percentile": 16892.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1771) Rep Dev, Urinary, W/Sling", "code_information": [ { "code": "C1771", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "additional_payer_notes": "165.00% of Medicare Rates", "median_amount": 3036.18, "10th_percentile": 3036.18, "90th_percentile": 3036.18, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C9359) Implnt,Bon Void Filler-Putty", "code_information": [ { "code": "C9359", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.9, "median_amount": 748.74, "10th_percentile": 748.74, "90th_percentile": 748.74, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell E0445) Oximeter Non-Invasive", "code_information": [ { "code": "E0445", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 695.05, "10th_percentile": 695.05, "90th_percentile": 695.05, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1760) Closure Device Vascular", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.9, "median_amount": 3774.77, "10th_percentile": 3774.77, "90th_percentile": 3774.77, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1781) Mesh", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.9, "median_amount": 5032.98, "10th_percentile": 3502.0, "90th_percentile": 6020.61, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 41.0, "median_amount": 1764.23, "10th_percentile": 1571.23, "90th_percentile": 4924.87, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "additional_payer_notes": "165.00% of Medicare Rates", "median_amount": 2299.36, "10th_percentile": 1669.98, "90th_percentile": 3603.56, "count": "1 through 10" } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4116.92, "discounted_cash": 852.0, "minimum": 87.3, "maximum": 4116.92, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1705.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 276.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 43.96, "median_amount": 1809.8, "10th_percentile": 1809.8, "90th_percentile": 1809.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 869.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1548.89, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1644.14, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1279.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1850.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1193.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1193.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1577.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1279.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1279.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1193.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1584.28, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1813.22, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1935.58, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1705.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 980.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 980.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1406.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1492.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 878.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1065.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1233.94, "discounted_cash": 259.0, "minimum": 27.22, "maximum": 1233.94, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 519.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 27.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 471.42, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.41, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 389.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 563.16, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 363.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.76 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 363.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 480.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 389.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.32 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 363.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 482.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 551.87, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 589.11, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 519.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 298.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 298.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 428.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 454.16, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 267.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 515.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 515.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 324.4, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1233.94, "discounted_cash": 852.0, "minimum": 87.3, "maximum": 1233.94, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 276.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 869.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1193.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1193.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1193.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 980.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 980.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1233.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 878.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 515.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 613.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 515.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1065.85, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2870.61, "discounted_cash": 986.0, "minimum": 24.55, "maximum": 2870.61, "payers_information": [ { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1381.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1381.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1825.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.53 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1381.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1832.99, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2097.88, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2239.45, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2870.61 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1134.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1134.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1627.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1726.45, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2870.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1016.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1233.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2870.61 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 24.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1006.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1792.05, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1902.25, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2870.61 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2140.79, "additional_payer_notes": "217.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdomen Surgery Procedure", "code_information": [ { "code": "22999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4945.03, "discounted_cash": 268.0, "minimum": 83.96, "maximum": 4945.03, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 83.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 273.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 487.37, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.34, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 402.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 582.21, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 375.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 496.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 402.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 375.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 498.5, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 570.54, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 609.04, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 308.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 308.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 442.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 469.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39540.8, "discounted_cash": 8483.0, "minimum": 188.44, "maximum": 39540.8, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16967.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 188.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19129.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8653.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15410.86, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.4 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16358.5, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12725.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 18409.89, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11877.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "case rate", "standard_charge_dollar": 10477.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.4 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11877.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15695.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12725.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12725.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.17 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11877.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15762.94, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 18040.84, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 19258.27, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16967.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9756.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9756.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "case rate", "standard_charge_dollar": 9687.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10477.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "case rate", "standard_charge_dollar": 16905.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13998.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 14846.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.4 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8738.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 31266.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 27752.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 31266.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 10604.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 18.0, "minimum": 3.22, "maximum": 92.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 39.93, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 39.13, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.08, "discounted_cash": 218.0, "minimum": 29.0, "maximum": 207.08, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 207.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.87 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 207.08 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.87 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.53 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 207.08 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 207.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 207.08 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 207.08 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 207.08 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 207.08 } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.0, "discounted_cash": 15.0, "minimum": 3.66, "maximum": 218.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 33.24, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 32.58, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.44 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 20.44 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 20.44 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.0, "discounted_cash": 16.0, "minimum": 4.03, "maximum": 242.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.34, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 35.87, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 38.29, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adjt/Reargmt F/C/C/M/N/Ax/G/H/F 10.1-30.0 Sq Cm", "code_information": [ { "code": "14041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4369.26, "discounted_cash": 2244.0, "minimum": 530.17, "maximum": 4369.26, "payers_information": [ { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 750.85 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4169.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4369.26, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4369.26, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4369.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3703.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3927.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2311.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2805.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4369.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4076.7, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4327.38, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4369.26, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4151.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Echo Img&Pst-Pxessing Tee/Tte Cgen Car Anomal", "code_information": [ { "code": "93319", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.81, "minimum": 7.99, "maximum": 137.81, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.83 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.83 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.81 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 137.81 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 137.81 } ] } ] }, { "description": "Hc Ag Detection Polyval If", "code_information": [ { "code": "87300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 11.0, "minimum": 2.86, "maximum": 115.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 27.19, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.71, "minimum": 20.05, "maximum": 882.71, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 200.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "fee schedule", "standard_charge_dollar": 882.71 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 264.81, "10th_percentile": 264.81, "90th_percentile": 264.81, "count": "1 through 10" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "fee schedule", "standard_charge_dollar": 882.71 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "fee schedule", "standard_charge_dollar": 882.71 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 882.71 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "fee schedule", "standard_charge_dollar": 882.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 882.71 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 882.71 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 882.71 } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 6.0, "minimum": 1.67, "maximum": 100.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.31 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 9.31 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 9.31 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4885.53, "discounted_cash": 986.0, "minimum": 75.0, "maximum": 4885.53, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 827.62 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 1134.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 1134.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1627.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1726.45, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 827.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 1016.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1233.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 853.22 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1006.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1792.05, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1902.25, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 853.22 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 2140.79, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1381.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.61 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1381.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1825.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1465.65, "10th_percentile": 1465.65, "90th_percentile": 1465.65, "count": "1 through 10" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.68 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1381.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1832.99, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 2097.88, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 2239.45, "additional_payer_notes": "227.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 14.0, "minimum": 3.45, "maximum": 208.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 31.38, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 26.87, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 30.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 32.82, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.5, "minimum": 132.37, "maximum": 978.5, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 132.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 978.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.21 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 978.5 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.21 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.77 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 978.5 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.21 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 978.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.21 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 978.5 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 978.5 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 978.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 978.5 } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 13.0, "minimum": 3.21, "maximum": 170.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 29.16, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 30.51, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.0, "discounted_cash": 32.0, "minimum": 7.79, "maximum": 313.0, "payers_information": [ { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 40.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 7.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 70.79, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 60.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 69.37, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 74.05, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 53.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 57.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 43.49 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 43.49 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 43.49 } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.0, "discounted_cash": 64.0, "minimum": 8.87, "maximum": 534.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 139.77, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.86 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 119.67, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 136.97, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 146.21, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 106.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 112.72, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 85.88 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 85.88 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 85.88 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 80.51, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus Ag Eia", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.0, "discounted_cash": 11.0, "minimum": 2.86, "maximum": 172.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 27.19, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Multiple Qual", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.0, "discounted_cash": 13.0, "minimum": 3.31, "maximum": 199.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.77, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 29.49, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 12.0, "minimum": 3.07, "maximum": 185.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 27.93, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.16 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 17.16 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 17.16 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Ther Amniotic Fluid Reduct", "code_information": [ { "code": "59001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1239.19, "discounted_cash": 331.0, "minimum": 61.27, "maximum": 1239.19, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 61.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1239.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.1, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 639.12, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1239.19 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 719.27, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.06 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 497.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.56 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 464.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 615.85, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 704.85, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 752.41, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1239.19 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 381.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 381.18, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 546.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 580.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1239.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 331.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 341.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 414.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1239.19 } ] } ] }, { "description": "Hc Adjt Tis Reargmt Eye/Nose/Ear/Lip 10.1-30.0 Sqcm", "code_information": [ { "code": "14061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3970.65, "discounted_cash": 2244.0, "minimum": 530.17, "maximum": 3970.65, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.28 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3970.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3703.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3927.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2311.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2805.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8106.12, "discounted_cash": 3559.0, "minimum": 546.72, "maximum": 8430.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6464.94, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6862.48, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7723.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 623.26 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6612.64, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7568.23, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8078.95, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5872.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6228.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Hc Adjt Tis Trnsfr/Rearrgmt E/N/E/L Dfct 10 Sq Cm/<", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6171.76, "discounted_cash": 2244.0, "minimum": 530.17, "maximum": 8430.55, "payers_information": [ { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4151.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 652.75 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4169.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4772.42, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5094.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3703.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3927.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2311.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2805.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2809.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4076.7, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4327.38, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4870.04, "additional_payer_notes": "217.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amputation Toe Interphalangeal Joint", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4486.68, "discounted_cash": 3559.0, "minimum": 364.31, "maximum": 10961.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7734", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7734.0, "10th_percentile": 7734.0, "90th_percentile": 7734.0, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.31 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 4486.68, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1969.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2947.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.7, "discounted_cash": 50.0, "minimum": 16.15, "maximum": 92.7, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 16.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 92.51, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 58.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 58.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 84.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 89.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 52.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 63.66, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434.0, "minimum": 50.0, "maximum": 16401.3, "payers_information": [ { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3537.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4293.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6238.66, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6622.29, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5256.33, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.63 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.72 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6381.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7303.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7796.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5666.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6010.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 16.0, "minimum": 2.86, "maximum": 153.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 34.87, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 29.86, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 34.17, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 36.48, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Spinal Selectv", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8531.49, "discounted_cash": 6052.0, "minimum": 50.0, "maximum": 8531.49, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 377.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.79 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.79 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.75 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 8531.49, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.79 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alkaloids Not Otherwise Specified - G0480 - 30080323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 588.0, "discounted_cash": 114.0, "minimum": 26.58, "maximum": 805.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 26.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 248.31, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 75.94, "10th_percentile": 75.94, "90th_percentile": 75.94, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 212.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 243.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 259.76, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 200.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28168.6, "discounted_cash": 6052.0, "minimum": 50.0, "maximum": 28168.6, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 9986.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 10592.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10994.53, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11670.6, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 9027.52, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.15 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11245.71, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12870.83, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 13739.38, "additional_payer_notes": "227.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 7.0, "minimum": 1.9, "maximum": 78.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.55 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.62 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 10.62 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 10.62 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14894.9, "discounted_cash": 3434.0, "minimum": 50.0, "maximum": 16401.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6238.66, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6622.29, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5256.33, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.7 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6381.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7303.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7796.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5666.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6010.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3537.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4293.05, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 7.0, "minimum": 1.25, "maximum": 72.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 16.97, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.63 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.0 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.0, "discounted_cash": 14.0, "minimum": 3.49, "maximum": 209.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 31.68, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 31.05, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 33.14, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein; Amniotic", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 17.0, "minimum": 4.0, "maximum": 240.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 36.89, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.59, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 36.15, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 38.59, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.0, "discounted_cash": 4.0, "minimum": 1.0, "maximum": 24.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.32 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 6.32 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 6.32 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amp F/Th 1/2 Jt/Phalanx W/Neurect Local Flap", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5306.56, "discounted_cash": 3559.0, "minimum": 546.72, "maximum": 5306.56, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4448.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 546.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3463.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 616.01 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 4092.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 5306.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3665.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.0, "discounted_cash": 8.0, "minimum": 2.07, "maximum": 390.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 5.9, "10th_percentile": 5.9, "90th_percentile": 5.9, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2019-Ncov Diagnostic P", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 0.01, "discounted_cash": 51.0, "minimum": 1.0, "maximum": 256.55, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 111.34, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 95.33, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 109.11, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 116.47, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.01, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 59.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 59.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 84.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 89.79, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 52.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 61.57 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 61.57 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 61.57 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 64.14, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8162.3, "discounted_cash": 3434.0, "minimum": 50.0, "maximum": 8162.3, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6238.66, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6622.29, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5256.33, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.03 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6381.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7303.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7796.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5666.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6010.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3537.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4293.05, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - 80337 - 30100422", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 805.0, "minimum": 1.0, "maximum": 805.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Hc 3D Rendering W/Interp&Postproc Diff Work Statio", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1130.94, "minimum": 46.5, "maximum": 1130.94, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 200.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1082.0 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.43 }, { "payer_name": "NV Preferred", "plan_name": "NV Preferred Coaliation", "methodology": "fee schedule", "standard_charge_dollar": 1083.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Fully Insured", "methodology": "fee schedule", "standard_charge_dollar": 948.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1082.0 }, { "payer_name": "Sierra", "plan_name": "Sierra Health Self Funded", "methodology": "fee schedule", "standard_charge_dollar": 1130.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1130.94 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 1130.94 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 1130.94 } ] } ] }, { "description": "Hc Antibody Detection Nos If", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.75, "discounted_cash": 16.0, "minimum": 2.86, "maximum": 118.75, "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 29.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 34.24, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 36.55, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 34.94, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antiepileptics Not Otherwise Specified 1-3 - G0480 - 30100444", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 588.0, "discounted_cash": 114.0, "minimum": 26.58, "maximum": 805.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 26.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 248.31, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 75.94, "10th_percentile": 75.94, "90th_percentile": 75.94, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 212.61, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 243.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 259.76, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 200.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1648.0, "discounted_cash": 300.0, "minimum": 87.3, "maximum": 1648.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 734.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 306.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 651.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 555.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 557.4, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 637.95, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 345.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 345.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 345.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 495.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 525.0, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 309.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 360.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 360.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 360.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 375.0, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 185.0, "minimum": 1.37, "maximum": 82.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.63 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 7.63 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 7.63 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 185.0, "minimum": 1.24, "maximum": 74.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.24 } ] } ] }, { "description": "Hc Acetylcholn Rcptr Modlg Antb", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12.0, "minimum": 2.11, "maximum": 60.25, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 25.62, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 27.35, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.25 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.03, "minimum": 45.39, "maximum": 949.03, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 860.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.39 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.03 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 949.03 } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.31, "discounted_cash": 10.0, "minimum": 2.43, "maximum": 108.31, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 23.11, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 17.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4577.32, "discounted_cash": 2244.0, "minimum": 530.17, "maximum": 4577.32, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4076.7, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4327.38, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 4577.32, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4151.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 612.77 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4169.84, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 4577.32, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 4577.32, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 2580.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 3703.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 3927.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 2311.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 2805.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1041.33, "minimum": 17.07, "maximum": 1041.33, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 568.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1041.33 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1041.33 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.07 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1041.33 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1041.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1041.33 } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.0, "discounted_cash": 12.0, "minimum": 2.89, "maximum": 174.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.42 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 27.44, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aerosol Inhalation Treat For Pneum Carinii", "code_information": [ { "code": "94642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 955.84, "discounted_cash": 238.0, "minimum": 13.41, "maximum": 955.84, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 242.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 432.65, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 459.26, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 357.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 516.85, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.31 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 442.54, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 506.49, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 540.67, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 273.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 273.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 393.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 416.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 245.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 297.73, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.69, "discounted_cash": 144.0, "minimum": 9.5, "maximum": 671.69, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 149.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 180.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 236.44 }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 9.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 43.96, "median_amount": 2480.0, "10th_percentile": 2480.0, "90th_percentile": 2480.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 262.88, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 236.44 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 314.04, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.68 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 268.89, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 307.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 328.51, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.35 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 166.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 166.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 238.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 253.26, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antipsychotics Nos 7 Or More - G0480 - 31080344", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 114.0, "minimum": 26.58, "maximum": 805.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 26.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Not To Exceed $7168", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 75.94, "10th_percentile": 75.94, "90th_percentile": 75.94, "count": "1 through 10" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.75, "discounted_cash": 11.0, "minimum": 2.86, "maximum": 240.75, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 27.19, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.12, "discounted_cash": 144.0, "minimum": 16.19, "maximum": 313.12, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 16.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 262.88, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 313.12 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 313.12, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 268.89, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 307.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 313.12, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 313.12 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 166.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 166.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 238.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 253.26, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 313.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 149.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 313.12 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 313.12 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 180.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 313.12 } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.0, "discounted_cash": 10.0, "minimum": 2.58, "maximum": 202.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alkaloids Not Otherwise Specified - 80323 - 30080323", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 588.0, "minimum": 1.0, "maximum": 588.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.69, "discounted_cash": 144.0, "minimum": 13.2, "maximum": 671.69, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 262.88, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.12 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 314.04, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.7 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 268.89, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 307.75, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 328.51, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 166.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 166.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 238.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 253.26, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 149.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 180.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.12 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9531.93, "discounted_cash": 803.0, "minimum": 92.6, "maximum": 9531.93, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 819.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1460.28, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1550.08, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1744.46, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1487.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.6 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1493.65, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1709.49, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1824.85, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 924.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 924.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1326.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1406.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 828.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1004.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 16.0, "minimum": 4.0, "maximum": 240.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 36.39, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.16, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 27.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12.0, "minimum": 2.11, "maximum": 12.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9531.93, "discounted_cash": 803.0, "minimum": 83.35, "maximum": 9531.93, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "case rate", "standard_charge_dollar": 530.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2444.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 819.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1460.28, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1550.08, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 1744.46, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1487.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.35 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1493.65, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 1709.49, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 1824.85, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 924.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 924.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 1326.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 1406.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 828.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 1722.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 2578.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 1004.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Amino Acid Single Qual", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.0, "discounted_cash": 14.0, "minimum": 3.31, "maximum": 199.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 30.77, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 30.15, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 32.19, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.3, "discounted_cash": 64.0, "minimum": 5.19, "maximum": 116.3, "payers_information": [ { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 73.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 105.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 112.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 66.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.54 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 38.54 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 38.54 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 80.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 73.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.51, "discounted_cash": 176.0, "minimum": 55.23, "maximum": 326.51, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 55.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 180.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 321.07, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 126.63 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 203.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 203.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 291.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 309.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 182.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 326.51 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 326.51 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 220.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.63 } ] } ] }, { "description": "Hc Amino Acids, 2-5 Quant", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.0, "discounted_cash": 19.0, "minimum": 4.03, "maximum": 162.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 42.55, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 36.44, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 44.51, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 34.32, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.53 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 23.53 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 23.53 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2289.69, "minimum": 50.0, "maximum": 2289.69, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1849.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.66 }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 548.76 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.66 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1279.59, "10th_percentile": 1279.59, "90th_percentile": 1279.59, "count": "1 through 10" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.99 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 532.3 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.66 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 532.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.66 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 548.76 } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 822.23, "discounted_cash": 176.0, "minimum": 19.79, "maximum": 822.23, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 180.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 321.07, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 340.81, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 338.39 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 383.55, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.53 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.66 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 328.4, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 375.86, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 401.22, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.24 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 203.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 203.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 291.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 309.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 182.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 220.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 338.39 } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434.0, "minimum": 50.0, "maximum": 16401.3, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6238.66, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.68 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6622.29, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 5256.33, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.68 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.71 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6381.19, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7303.34, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7796.18, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 3949.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 5666.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 6010.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.68 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 3537.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 4293.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1275.35, "discounted_cash": 333.0, "minimum": 19.73, "maximum": 1275.35, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1275.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 606.49, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 643.79, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Anthem BCBSNV Worker Comp", "plan_name": "Anthem BCBSNV Worker Comp", "methodology": "case rate", "standard_charge_dollar": 1275.35 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 724.52, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.37 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.5 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 620.35, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 710.0, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 757.91, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1275.35 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 383.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 383.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 550.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 584.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.37 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1275.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 343.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "case rate", "standard_charge_dollar": 252.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "case rate", "standard_charge_dollar": 378.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 417.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1275.35 } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Elisa", "code_information": [ { "code": "86051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1500.0, "discounted_cash": 11.0, "minimum": 2.02, "maximum": 1500.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 2.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 25.02, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 24.52, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 26.17, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7932.03, "discounted_cash": 6052.0, "minimum": 50.0, "maximum": 7932.03, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "181.65% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "192.82% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.49 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 6960.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 7932.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 6234.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 7565.74, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 15.0, "minimum": 3.59, "maximum": 145.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 34.16, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 26.34, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.08 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 20.08 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 20.08 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh Phenotype", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 40.0, "minimum": 1.85, "maximum": 111.0, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 73.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 56.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 56.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 75.47, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 86.38, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 92.21, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 46.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 46.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 67.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 71.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 41.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 50.78, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3378.4, "minimum": 50.0, "maximum": 3378.4, "payers_information": [ { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.81 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.81 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 228.0 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 329.0 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 228.0 } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.6, "discounted_cash": 5.0, "minimum": 1.24, "maximum": 105.6, "payers_information": [ { "payer_name": "6 Degrees", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Access to Healthcare Network", "plan_name": "Access to Healthcare Network", "methodology": "fee schedule", "standard_charge_dollar": 1.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Custom Ink", "plan_name": "Custom Ink", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "217.00% of Medicare Rates" }, { "payer_name": "Employer Direct", "plan_name": "Employer Direct Surgery", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "Optum Care", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC", "plan_name": "UHC Options", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC Adhoc", "plan_name": "UHC Adhoc", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Veterans Evaluation Service VES", "plan_name": "Veterans Evaluation Service VES", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins/Agglutinins Auto", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.0, "discounted_cash": 8.0, "minimum": 1.96, "maximum": 119.0, "payers_information": [ { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Health Plan of Nevada", "plan_name": "HPN Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Home Town Test", "plan_name": "Washoe County Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.71 }, { "payer_name": "Molina Healthcare Of NV", "plan_name": "Molina Healthcare Of NV Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Washoe County", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "NEVADA HEALTH PARTNERS", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "185.80% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed PHCN", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "212.65% of Medicare Rates" }, { "payer_name": "NV Preferred", "plan_name": "NV Prefereed UHCN", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "227.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "PAM", "plan_name": "PAM", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Renal Payor Solution Medicare", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Saint Mary health Plan", "plan_name": "Saint Mary Health Plan Medicare Atrio", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Sierra", "plan_name": "Sierra Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial (Insurance Exchange)", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercials", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest Medicare (1/1/2025 - 12/31/2026)", "methodology": "fee schedule", "st